[Transvaginal tubal ligation]. / Laqueadura tubaria pela via transvaginal.

PIP: Vaginal tubal ligation is a simple procedure, offers minor surgical risks, and has few contraindications. The authors consider it the surgical contraceptive of choice in selected cases. From July 1975 to March 1983 the authors performed 155 tubal ligations by the vaginal route after posterior colpotomy. For each patient opinions were sought from at least 3 physicians, who advised regarding the medical or psychological need for sterilization. The median age was 35 years, with ages ranging from 23 to 48. Median parity was 5.3, with 57 patients having 6 or more children. All were from low socioeconomic backgrounds. 140 tubal sterilizations were done by the Pomeroy method, in 14 by the Pomeroy method on 1 side and fimbriectomy on the other, and in 1 patient a bilateral fimbriectomy was performed. In 3 patients the tubal ligation was completed by abdominal route because of difficulty of vision during colpotomy. All patients recovered well postoperatively, with minimal pain. All received antibiotic therapy with penicillin for 5 days following surgery. Average duration of surgery was 42 minutes. There were no occurrences of lesions, hemorrhages, abcesses, or infection of incisions. With an average follow-up of 41.2 months, the incidence of problems was 0.65%. Contraindications against using the vaginal route include a history of pelvic inflammatory disease, anterior gynecological surgery, alterations in the mobility or size of the uterus, and presence of adnexal tumors. Colpotomy presents several advantages: it is well accepted by the patient because there is no abdominal scar, it is an efficient method that does not require special apparatus such as optical or mechanical equipment, it is associated with minimal morbidity, and there are few complications. Additionally, surgery is of short duration, postoperative pain minimal, and it is economical because hospitalization time is short, with rapid convalescence. Disadvantages observed were: it is not applicable to all patients and requires major surgical training to perform; it requires an extended period of postoperative sexual abstinence, usually 4 weeks. This procedure cannot be used during the immediate postpartum period, with a recommended interval of 6 weeks. Tubal sterilization using posterior colpotomy, in view of the advantages and results obtained, is recommended for selected cases.^ieng