Tubal sterilization by minilaparotomy under local anesthesia

Minilaparotomy under local anesthesia (ML/LA) is the most widely used technique of tubal sterilization in the world. Since 1993, the University Hospital Center of Dakar, Senegal has been the reference center performing 20 ML/LA a month. Most procedures (72%) are carried out for non-medical personal reasons. The remaining cases (28%) involve physical conditions incompatible with completion of normal pregnancy. In all cases, voluntary, informed consent is obtained from the couple and is documented in writing. Preoperative evaluation is performed to detect contraindications. The procedure consists of five steps: the vaginal phase, local anesthesia, abdomen incision, tubal ligation, and closure. Morbidity is less than 1%. The most common complications involve damage to visceral organs (intestine, bladder). These injuries are accessible to immediate repair and thus have a good prognosis. Failure rate due to technical error is low (average: 5.8/10,000). Current experience shows that ML/AL is a safe, effective, low-cost technique well suited to use in developing countries.