Complications and difficulties faced during laparoscopic tubal ligation using single-puncture technique in scarred abdomen

Abstract

This study was carried out in Dr. MK Shah Medical College and SMS Multispeciality Hospital, a tertiary care medical center, catering to Lower middle class and middle-class communities.
Objective: To evaluate the difficulties faced during laparoscopic tubal ligation and complications that occurred during or after laparoscopic tubal ligation in the scarred abdomen using the single-puncture technique and its outcome.
Methodology: A prospective study was carried out in tertiary care medical center in the periphery of the metropolitan area from 1st January 2022 to 30th September 2023. Consent of the ethical committee of the hospital and written consent of the patient were taken. All patients with a history of previous pelvic/abdominal surgery undergoing laparoscopic tubal ligation with a fallopian ring were included in the study and any difficulties faced or complications that occurred were noted. Patients undergoing the concomitant procedure (MTP/D&E/Check curette) with Lap TL were also included.
Results: A total of 41 patients were included in the study. 46.3% patients were in the age group of 25−30 years. There was only a marginal difference of around 3% between the age group of >30 years. The majority of patients were up to G3 (85.4%). Patients accepted laparoscopic tubal ligation if they had more than 2 children. Preoperative assessment should be done thoroughly by senior faculty. Fixed mobility is an ominous sign to take patients for Lap TL. Normally these findings are the same in patients with 3 scars on the abdomen and having a history of closure
of the abdomen in single layer. 80% of patients undergoing Lap TL had a history of previous 2 CS. 12.5% of patients had a history of previous 3 Lower Segment Cesarean Section (LSCS). 1 out of 41 pt had operative h/o 2 LSCS + open appendicectomy. 1 pt had operative h/o 2 LSCS + 3 Lap surgeries for surgical pathology. 1 pt had an exclusive history of open appendicectomy. The majority of patients, 78.1%, had interval Lap TL. 17.1% had concurrent Lap TL with suction & evacuation. 4.8% had Lap TL following the 2nd trimester MTP. In 75.6% of patients, there was no difficulty in applying fallopian ring. 19.5% of patients who had peritubal adhesions were
taken care of while doing single-puncture Lap TL. Complications were comparable with those of non-scarred abdomen undergoing Lap TL.
Conclusion: Lap TL in a patient with a scar on the abdomen is a preferable method rather than Laparotomy. Junior gynecologists should take the help of senior gynecologists conversant with doing Lap TL in patients with scarred abdomen. Complications are comparable with those of Lap TL in non-scarred abdomen. The abdomen should be closed in layers. It should be standard protocol for all gynecologist practicing universally. Scar/scars on the abdomen is not a contraindication of Lap TL.