Bilateral Tubal Ligation

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An exclusive production by the Sarawak General Hospital O&amp;G Department on how to perform the Bilateral Tubal Ligation or BTL.

<li>Before operations: confirm patient’s last menstrual period, exclude pregnancy and take necessary consents</li>
<li>Ensure the OT check list board is properly filled and empty urinary bladder with in out catheter.</li>
<li>After proper gowning and scrubbing, the operative area is cleaned and draped.<a href=”http://www.sgh-og.com/wp-content/uploads/2014/03/btl.jpg”><img class=”size-thumbnail wp-image-223 alignright” src=”http://www.sgh-og.com/wp-content/uploads/2014/03/btl-150×150.jpg” alt=”btl” width=”150″ height=”150″ /></a></li>
<li>Determine the incision site and size – 2 fingers from the symphysis pubis superiorly.</li>
<li>Make the skin incision about 3 to 4 cm long.</li>
<li>Open the abdomen in layers until the rectus sheath.</li>
<li>Open the rectus sheath using the scissors and push the muscle laterally.</li>
<li>Proceed to open the peritoneal cavity with two artery forcep and the maximburm scissors.</li>
<li>By using 2 fingers – identify the uterine body and move laterally to identify the fallopian tube.</li>
<li>Grasps the tube using the babcock. The tube can be determined by identifying the fimbriae end of the tube.</li>
<li>Lift the tube gently and clamp the area for incision using the artery forceps.</li>
<li>Make a knot on one side and subsequently on the opposite site. Be sure to relief the artery forceps temporally when making the knot.</li>
<li>Any absorbable suture size 2/0 can be used – eg. Ecosord, Vicryl or catgut</li>
<li>The tube can then be excised using the scissors.</li>
<li>The stump is then inspected for any residual bleeding.</li>
<li>The same procedure is employed for the contralateral tube.</li>
<li>Secure any bleeding on the muscle, rectus as well as the fat layer.</li>
<li>Identify the rectus sheath at its angle and grasp with the artery forceps. Then start closing the rectus using any absorbable suture size 1 – eg. the vicryl or ecosorb.</li>
<li>Finally close the skin by the subcuticular technique using any absorbable suture – eg. monosyn 3/0</li>