Modified Pomeroy's Tubal Ligation: Optimal Suture Selection
For modified Pomeroy's tubal ligation, chromic catgut (Option C) is the traditional and most appropriate choice, as it provides adequate tensile strength during the critical healing period while absorbing predictably to allow tubal separation and permanent occlusion. 1, 2
Rationale for Chromic Catgut
Chromic catgut is specifically designed for tubal ligation procedures because its absorption timeline (14-21 days) allows the ligated tubal segment to necrose and separate, creating permanent sterilization. 3
The suture must absorb relatively quickly to permit tubal devascularization and tissue necrosis, which is the fundamental mechanism of the Pomeroy technique. 3
Plain catgut absorbs too rapidly (5-7 days) and may cause premature knot failure before adequate tissue necrosis occurs. 3
Why NOT the Other Options
Vicryl (Option A) - Suboptimal Choice
Vicryl retains tensile strength for 2-3 weeks with complete absorption taking 56-70 days, which is too prolonged for Pomeroy's technique and may interfere with the intended tubal separation mechanism. 4, 5
While Vicryl causes less tissue inflammation than catgut, this property is actually disadvantageous in tubal ligation where you want controlled tissue necrosis. 4, 3
Vicryl is excellent for tissue approximation in reconstructive surgery but counterproductive when tissue destruction is the goal. 4
PDS (Option D) - Inappropriate Choice
PDS maintains 50% tensile strength at 6 weeks and takes 180-210 days for complete absorption, making it entirely unsuitable for Pomeroy's technique. 6, 5
PDS causes minimal inflammatory response and promotes tissue healing rather than necrosis, directly opposing the surgical objective. 6
The prolonged absorption profile prevents the intended tubal separation and may lead to recanalization failure. 5
Plain Catgut (Option B) - Too Rapid
Plain catgut loses tensile strength within 5-7 days, risking premature knot failure before adequate tubal devascularization. 3
The absorption is too unpredictable and may compromise the procedure's effectiveness. 3
Critical Technical Points
Use 0 or 2-0 chromic catgut for adequate knot security and tissue handling during the Pomeroy procedure. 3
Ensure the suture ligates a 2-3 cm segment of fallopian tube in the mid-isthmic portion for optimal failure rates. 7
The knot must remain secure for 10-14 days to allow complete ischemic necrosis of the ligated segment before absorption begins. 3
Common Pitfall to Avoid
Do not use modern synthetic absorbable sutures designed for tissue approximation and healing (Vicryl, PDS, Maxon) in procedures where controlled tissue necrosis is the intended outcome. These materials were specifically developed to minimize inflammation and promote healing, which directly contradicts the mechanism of tubal ligation. 4, 6