Re: mám jít do steriliziace?

Tady jsou pouzivane techniky...asi by bylo dobre se i pidit po tom jakym stylem ke sterilizaci dochazi...

The actual technique used to perform a tubal ligation involves first isolating the fallopian tubes by identifying the fimbriated end of the tubes. This is a very important step so that any other structure such as the round ligament is not ligated by mistake. The tube is then ligated, using any of the following techniques

Pomeroy Technique
This is the most commonly performed technique for puerperal tubal ligation. The mid portion of the fallopian tube is lifted by means of a Babcock clamp to form a loop, which is tied with plain catgut suture. The top of the loop is cut off and the closed ends of the tube move away from each other from each other, creating a gap of 2 to 3 cm between the cut ends of the tube. A similar procedure is done on the other tube.

There are many different modifications of the Pomeroy technique.

Uchida Technique
In this method, about 5 cm of the muscular tube towards the uterine end is cut off but the fimbriated end is left untouched. For puerperal ligation, this procedure is modified by performing a fimbriectomy (removal of the fimbrial end of the tube). In essence, this is a salpingectomy (removal of the fallopian tube) since the fimbria, along with a large portion of the tube, is resected. The low failure rate achieved with this technique is due to such a large segment of the tube being removed.

Parkland Technique
This method is similar to Pomeroy technique, but each limb of the loop is tied separately. This helps to separate the cut ends of the tube and thus reduces risk of recanalization.

Irving Technique
The tube is lifted and cut. The cut proximal end (uterine end) of the tube is buried in a tunnel in the anterior uterine wall. This technique is designed to be used along with a Cesarean section.

Sterilization by Fimbriectomy
The tube is lifted a little away from the fimbrial end. Double ligations are placed near the fimbrial end and the tube is cut between the sutures.

Madlener Technique
This procedure is similar to Pomeroy but without tubal resection. The tubes are crushed and ligated with non-absorbable suture.

Mechanical Techniques
This technique involves blocking the tubes by means of mechanical devices such as

Falope ring – a non-reactive silicone rubber band is placed around a loop of the tube by means of an applicator.
Hulka clip – a plastic clip is placed across the tube which is held in place by a steel spring.
Filshie clip – a titanium and silicone clip is used.
This technique causes less tissue damage and may give better chances of reversal.

Electrodesiccation Technique
Electrosurgery is preferred when the tubes are swollen or cannot be easily mobilized for placement of a mechanical device. Use of bipolar current may be safer than unipolar current and causes less tissue damage.

In bipolar tubal ligation, the mid portion of the tube is grasped and held up between two poles of the bipolar forceps and an electrical current is applied, which passes through the tube between the two ends of the forceps. There is s greater chance of tubal damage with this procedure hence less chance of reversal.