Mini-Laparotomy for Tubal Ligation

A mini-laparotomy (also known as a mini-lap) is one of the three most common methods of tubal ligation. These elective forms of surgical contraception are often referred to as "having your tubes tied." The other techniques include laparotomy and laparoscopy.

The mini-lap is a less invasive form of a laparotomy. It involves a smaller incision and is performed at the time of or just after childbirth. A laparotomy, by contrast, is performed at any time and requires a larger incision because the fallopian tubes are less accessible. 

The third option, laparoscopy, is a sophisticated surgical procedure in which a fiber-optic device is inserted through the abdominal wall through a keyhole incision. It is a minimally invasive procedure that can often be performed on an outpatient basis.

Comparing Mini-Laparotomy and Laparoscopy

The mini-lap is a common procedure that is known to be safe and effective in preventing future pregnancies by stopping a woman's eggs from reaching her fallopian tubes where fertilization takes place.

It poses several advantages over laparoscopy in that it requires less sophisticated equipment, less skill to perform, and can be performed in the hospital either immediately after delivery or before being discharged. Most often, it is performed within 48 hours of childbirth.

Complications from a mini-lap are slightly higher than those for a laparoscopy, but, in both cases, they are relatively rare. If they do occur, they tend to be associated with the pregnancy itself rather than the procedure.

How the Surgery Is Performed

Many surgeons prefer to perform a tubal ligation shortly after childbirth. This is because you are already in the hospital, and your abdominal wall is relaxed. In addition, pregnancy pushes the top of your uterus near the belly button where the incision would be made. This allows for easier access to the fallopian tubes.

For a mini-laparotomy, you will be given either a general or regional anesthesia (most commonly an epidural). The surgery would then be performed in the following steps:

• The surgeon will make a small but visible incision right beneath the umbilicus.
• The fallopian tubes will then be pulled up and out of the incision.
• The tubes will then be put back into place and the incision closed with stitches.

Most women recover in a few days or longer if the incision is big. Complications are uncommon but may include infection (both internal and at the incision site) and separation of the tied tubes.

Risk of Pregnancy Following a Mini-Laparotomy

The odds of becoming pregnant after a tubal ligation is 1.2/1,000 in the first one to two years and 7.5/1,000 over seven to 12 years, so it is considered a very effective means of birth control. While the odds are low, a woman may become pregnant after a mini-laparotomy if the following occurs:

• The surgery fails to close the passageway in one or both of the fallopian tubes.
• The fallopian tubes grow back together again.
• Recanalization occurs, resulting in the formation of a new passage which allows the egg and sperm to meet.
• The woman was already pregnant when the surgery was performed.

Becoming pregnant after a mini-laparotomy carries an increased risk of an ectopic pregnancy, a condition wherein the fetus develops outside of the uterus (most commonly in a fallopian tube).

Ectopic pregnancy is a serious medical condition and, if left untreated, can lead to the rupture of the fallopian tube, internal bleeding, shock, and even death. Symptoms include the stoppage of menstrual periods, vaginal bleeding, lightheadedness, shoulder pain, and severe abdominal or pelvic pain.

Symptomatic ectopic pregnancy is considered a medical emergency in need of immediate care.