Tubal sterilization is a permanent surgical contraception for ladies which involves ligation the fallopian tubes and prevent ova from going outside the ovaries.

Female sterilization, a prevalent form of contraception worldwide, has witnessed a decline in prevalence from 13.3% in 1994 to 11.5% in 2019 [1]. This trend reflects shifting patterns in contraceptive preferences and reproductive healthcare.

Central to female sterilization is the choice between laparoscopic and open surgery for tubal ligation, each with distinct advantages and considerations. Safety issues, hospital stay, costs and surgeons’ experience are important factors in decision-making of the method for female sterilization [2]. In laparoscopic surgery, smaller incisions in the abdomen are made compared to the much larger ones in the traditional surgery to access the fallopian tubes directly, which requires a longer recovery time and more pain compared to laparoscopic tubal ligation. Both methods are effective but differ in their invasiveness, recovery time, and potential complications.

Female sterilization, encompassing various surgical techniques such as tubal ligation, remains one of the most prevalent forms of contraception worldwide. Tubal sterilization can also be accomplished via an open approach. If the patient undergoes a cesarean delivery, tubal sterilization is performed immediately following hysterotomy closure and before closing the abdominal incision. Following a vaginal delivery, tubal sterilization is typically accomplished through a mini-laparotomy under regional anesthesia. Additionally, a mini-laparotomy may be used in patients with significant risks for laparoscopy and in settings with limited laparoscopic resources [3].

Undertaking research in a developing nation like Jordan holds pivotal significance for advancing global health equity by tailoring interventions to meet distinct needs and overcome unique challenges. There is no data about the tubal ligation method of contraception in Jordan; however, there is a study conducted in 2023 in Jordan about family planning, mentioned that between the years 2012 and 2017–2018, Jordanian fertility rate decreased to 2.7 children/woman. The contraceptive usage rate in Jordan among ladies 15–49 years old increased from 40% in 1990 to 61% in 2012. However, that increase was almost entirely involving traditional methods. During the year 2019, 50% of ladies adopted a contraceptive method; 37% of those aged 15–49 years used a modern method and 14% used a traditional contraceptive. Intrauterine contraceptive devices that was used by 21% of women were the most popular modern contraceptive followed by the pill by 8% and male condoms that was used by 5% [4].

This study aligns with broader efforts to enhance contraceptive practices and reproductive health services, and to combat the paucity of data on women of the middle east, incorporating recent evidence and global trends in female sterilization.

This retrospective study aimed to compare the outcomes of tubal ligation between females who underwent laparoscopic surgery versus open surgery. Data were collected from medical records both paper-based and electronic files and virtual calls after obtaining verbal consent from patients. Patients included in the study underwent tubal ligation surgery between 2010 and 2021 at Jordan University Hospital (JUH). The study protocol was approved by the JUH institutional ethics committee.

Data were collected on various parameters, including age, type, and date of tubal ligation surgery, gravidity (defined as the total number of previous pregnancies), parity (defined as the number of pregnancies that completed 20 weeks of gestation or more), and the occurrence of pregnancy (indicating failure of tubal ligation). Laparoscopic tubal ligation was done by consultant gynecologist using 12 mm umbilical trocar incision and two 5 mm trocar incisions; one suprapubic and the other in the left iliac fossa. Due to the lack of tubal clips and rings, partial salpingectomy involving removal of the middle third of the tube using bipolar diathermy device was performed. The excised segments were routinely sent for histopathological examination.

In our study, all patients underwent sampling for histopathological examination by extracting a segment from their fallopian tubes. We ensured that the procedures were correctly performed for each patient, and that the samples collected were indeed from the fallopian tubes.

Cases of open tubal sterilization were done in a standard Pomeroy technique using absorbable sutures and the removed tubal segments were also sent routinely to histopathological examination. The minimum post-operative follow up was 2 years.

In this study, 242 females who underwent tubal ligation were included. 131 had open surgery and 111 had a laparoscopic surgery. The median follow-up period for the cohort was 8 years. For the entire study cohort, the mean age at the time of surgery was 37.77 years (standard deviation (SD) = 4.589). The difference in age between the laparoscopic surgery and open surgery groups was statistically significant (p 0.0001), with mean age being older in the laparoscopy group (Table 1). The median gravidity (previous deliveries) was 6, ranging from 1 to 20, and the median parity (previous pregnancies) was 6, ranging from 0 to 19. However, there were no significant differences between the two groups in terms of gravidity (p = 0.9499) or parity (p = 0.4867). The majority of the open surgery patients (120, 91.60%) had their tubal sterilization done during cesarean section.

Remarkably, only two pregnancies were documented during the follow-up period, both of which were observed in the laparoscopic surgery group. Overall free-from-pregnancy rate at 8 years was 98.79%; 97.59% in the laparoscopy group and 100% in the open surgery group. As no events occurred in the open surgery group, Log-rank test is not feasible. Instead, a Fisher’s exact test conducted to compare pregnancy occurrences between the laparoscopic and open surgery groups revealed no significant difference (p = 0.2094).

One of the pregnancies that occurred was detected 8 years after laparoscopic tubal ligation surgery. At an estimated gestational age of 2–3 weeks, the pregnancy was detected, and was found to be ectopic, and was terminated.

Our findings shed light on various aspects of this procedure, including age distribution, and pregnancy occurrences, adding to the existing body of knowledge surrounding female sterilization techniques.

Conducting research in developing countries like Jordan is vital for achieving global health equity. By including diverse populations in research studies, we can better understand the nuances of healthcare delivery and outcomes, ultimately facilitating more tailored and effective interventions. Our study exemplifies the importance of localized research efforts in addressing the specific needs and challenges faced by populations in resource-constrained settings.

The relatively small-sized study was due the fact that women in Jordan usually need big families and this might have contributed to significantly less tubal ligation in this region [5].

Permanent contraceptives in Jordan and globally are mostly tubal ligation with very rare vasectomy [6].

An earlier Jordanian study investigated factors influencing the use of long-term and permanent contraceptives among married women in Jordan [7]. Notably, non-hormonal intrauterine contraceptive device (IUCD) were the most common method, while tubal ligation was adopted by only 3.22% of participants, largely influenced by cultural and religious factors [7]. Only 1.83% of women’s husbands in Jordan had vasectomy [7]. Another study on the quality of life (QoL) of Jordanian women using the World Health Organization Quality of Life-Brief version (WHOQOL-BREF) questionnaire found that women who underwent permanent sterilization exhibited lower QoL scores across all domains [8].

Age emerged as a notable factor influencing the choice of surgical approach and potentially impacting the outcomes of tubal ligation. Our study revealed a statistically significant difference in the mean age between patients undergoing laparoscopic and open surgery, with laparoscopic procedures being favored by younger individuals. This observation aligns with recommendations of previous studies [9]. It raises intriguing questions regarding patient preferences, surgeon recommendations, and the influence of evolving surgical practices on clinical decision-making.

Remarkably, our study documented only two pregnancies during the follow-up period, both occurring in the laparoscopic surgery group. Despite the low overall incidence of pregnancy post-tubal ligation, the occurrence of pregnancies after laparoscopic surgery warrants attention. Notably, one of these pregnancies was ectopic, emphasizing the importance of vigilant postoperative monitoring and counseling regarding the possibility of rare but serious complications. This finding echoes previous research highlighting the need for thorough preoperative counseling and informed decision-making regarding permanent sterilization methods [10]. Comparing the safety profiles of laparoscopic and open techniques previous research indicates similar safety outcomes for both approaches [11].

It is essential to acknowledge the limitations of our study, including its retrospective nature and potential biases inherent in the data collection process. Additionally, long-term follow-up studies are warranted to assess the durability and efficacy of tubal ligation over time.

The evolving landscape of female sterilization techniques warrants ongoing evaluation and scrutiny. Recent advancements, such as bilateral salpingectomy, have sparked discussions regarding the optimal approach to permanent contraception [11]. While our study focused on traditional tubal ligation methods, future research should explore the comparative effectiveness and safety of emerging techniques, considering factors such as ovarian cancer risk reduction and long-term contraceptive efficacy.

Both open and laparoscopic tubal sterilization are equally effective permanent contraceptives. While our study contributes to the understanding of tubal ligation outcomes, further research, particularly in developing countries like Jordan, is warranted to address the unique needs and challenges of diverse populations in reproductive healthcare.

Data are available from the corresponding author on reasonable request.

NAH: concept, design, writing and interpretation; SA: conception, design; NAF: data collection; AAlhusban: analysis; ZF: acquisition; MH: acquisition; MAA: acquisition; AAlzibdeh: acquisition, analysis; LAO: analysis; RA: interpretation. All authors contributed to editorial changes in the manuscript. All authors read and approved the final manuscript. All authors have participated sufficiently in the work and agreed to be accountable for all aspects of the work.

The study obtained IRB approval from Jordan University hospital, decision number 254/2022, dated 5/9/2022. All subjects gave their verbal informed consent for inclusion before they participated in the study. The study was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the Ethics Committee. Written informed consent was not required by the ethical committee as was a retrospective study.

This research received no external funding.

The authors declare no conflict of interest.