What you need to know about LRT [Ligation and Recession of Tubes]

Much has been spoken about sterilisation of women over the past few weeks. Although it’s a simple procedure that is being done to ideally reduce the risk of more pregnancy complications (after the third Caesarean section delivery), many claim that it could be deliberately done to prevent child birth. Ethics and attitudes play a major role in the medical profession as it is acknowledged as another one of those noble professions. Consent is a must when it comes to the Ligation and Recession of Tubes (LRT) surgery. 

In this backdrop, the Health Capsule spoke to Dr. Chinthana Hapuachchige, Gynaecological Oncological Surgeon (MBBS, MD, MRCOG) at Apeksha Hospital, Maharagama to shed light on this procedure and its risks and benefits on a patient’s health. 

Tubal ligation is one of those procedures that need to be done after taking the consent from not only the patient, but both the patient and the husband

The gynaecologist would examine the ovaries and other organs and see if they are normal, before the procedure is done. He will also check the tubes etc

While the patient is under anaesthesia, one or two small incisions are made in the abdomen, usually near the navel and a laparoscope is inserted through the incision

The procedure 
“The structure of the Fallopian Tubes are such that they consist of microscopic cilia,” said Dr. Hapuachchige in his opening remarks. “Cilial action helps the release of the egg by pushing it towards the womb. It is only then that it gets fertilised. Fallopian Tubes have mechanical patency as well as functional patency. But these cilia could be damaged either due to infections such as chlamydia or other vaginal infections or it could be mechanically damaged. In that way, the functional patency of the Tubes will be destroyed. Since cilia are delicate organs, an accidental squeezing of tubes could also stop the function.” While the patient is under anaesthesia, one or two small incisions are made in the abdomen, usually near the navel and a laparoscope is inserted through the incision. Using instruments that are inserted through the laparoscope, the tubes are coagulated, burned or obstructed using a small clip. The skin is then closed with a few stitches. While some women would return to their normal work in a few days’ time, others would be advised to take rest. A tubal ligation could be done immediately after child birth or during a C-section. 

Taking consent 
Tubal ligation is one of those procedures that need to be done after taking the consent from not only the patient, but both the patient and the husband. “Without consent we can’t remove any organ from the body. In this case both parties should agree.,” Dr. Hapuachchige further said. “The patient should be over 18 years of age. We advice them that this is a permanent procedure and once the patient sign the consent form,  the surgery could be done during an ante-natal clinic. But on the other hand, there’s a failure rate of one in 200 cases. Therefore, we have had cases when women have become pregnant even after they have done an LRT surgery.”

According to Dr. Hapuachchige, a female is adviced to conduct an LRT after she has done the third C-section. “It is not compulsory, but to avoid certain complications following pregnancy, we sometimes advice women to do this surgery. But the patient has an absolute right to refuse.”

He also said that if a mentally incapable female gets pregnant, an LRT procedure is done with the consent of two individual consultants along with a court decision. “Even if it is a life-threatening case we still need to seek consent from an individual consultant,” he added.

Other procedures prior to the surgery 
“When conducting a C-section there are certain procedures that need to be met,” Dr. Hapuachchige said. “Here, the gynaecologist would examine the ovaries and other organs and see if they are normal, before the procedure is done. He will also check the tubes etc. Sometimes during a C-section there is a tendency for blood and lipids to enter the tummy and vagina areas. So doctors are advised to check for such complications. Once they examine the tubes, ovaries and other organs, they would make small notes and ensure that everything is macroscopically checked.”

He further said that there could be chances when the tubes could be accidentally squeezed in such an instance. 

Risks and benefits to health 
It is understood that once done, this procedure is irreversible. “One of the main advantages in doing an LRT is reducing the risk of developing ovarian cancer,” he said. “On the other hand a female can also reduce the risk of having unwanted or unplanned pregnancies. With LRT, the maternal mortality rate has also reduced.”