Which sterilization method should I choose? Tube removal (salpingectomy) or clips, cut & burn, bands, etc. (tubal ligation) Bilateral salpingectomy is now considered the standard of care over tubal ligation. Both fallopian tubes are removed.

The traditional method of tubal sterilization is tubal ligation, in which the fallopian tubes are blocked, occluded, or interrupted by clips, coagulation (cut & burn), bands, fallope rings, removing a segment of each tube, or another method of tubal ligation.

As of 2015, the American College of Obstetricians and Gynecologists (ACOG) recommend that bilateral salpingectomy, the removal of the visible portion of both fallopian tubes, replace tubal ligation as the standard of care for tubal sterilization.

The ACOG writes in their Opinion Statement from Jan. 2015 (Reaffirmed 2017) that “Salpingectomy as a means of tubal sterilization appears to be safe, without an increase in complications, such as the need for blood transfusions and readmissions, compared with tubal ligation.” Removal is only slightly more invasive than ligation, with one extra incision (salpingectomies generally require 3 incisions while ligations usually require 2) and 10 minutes more OR time. Both procedures are performed laparoscopically under general anesthesia. The recovery and risks are basically identical.

Bilateral salpingectomy is also thought to reduce your risk of ovarian cancer, which recent research suggests starts in the tubes. Here is a summary of current research: Many Ovarian Cancers May Start in Fallopian Tubes - National Cancer Institute

Bilateral salpingectomy as a contraceptive sterilization method is virtually 100% effective at preventing pregnancy, with no recorded viable pregnancies post-procedure. There are only 4 cases of pregnancy after bilateral salpingectomy in the medical literature and they were all nonviable - Case 1, Case 2 (PDF), Case 3, Case 4. They are nonviable ovarian ectopics or tubal ectopics in the stump. In all 4 cases, the full texts contain surgical pictures showing the procedure was performed correctly and both tubes were correctly removed.

Also, all 4 cases are from before bilateral salpingectomies were widely performed for the purpose of sterilization. It is possible that as more bilateral salpingectomies are performed, more cases of pregnancies could arise. Nevertheless, the efficacy can be estimated at essentially 100%. Since there are no tubes that can recanalize, and there’s a very tiny possibility of fistula formation, it is extremely unlikely to fail.

Here is an article published in 2015 with different perspectives: Should salpingectomy be standard of care at time of bilateral tubal ligation?

!tubalfacts