A bisalp, short for bilateral salpingectomy, is a surgical procedure that removes both fallopian tubes entirely. It’s a permanent form of sterilization and one of the most effective methods of preventing pregnancy. The procedure is typically done laparoscopically through small incisions, and most people recover within one to two weeks.
How the Procedure Works
During a bisalp, a surgeon removes both fallopian tubes completely rather than cutting, clipping, or blocking them (which is what happens during a tubal ligation). The surgery is usually performed laparoscopically, meaning the surgeon works through a few small incisions using a thin instrument with a camera and light attached. Because the tubes are removed rather than simply disrupted, there’s essentially no remaining pathway for an egg to travel from the ovaries to the uterus.
The procedure itself typically takes around 15 to 20 minutes for the sterilization portion when done laparoscopically. It’s performed under general anesthesia, and most people go home the same day.
Bisalp vs. Tubal Ligation
The key distinction is removal versus interruption. A tubal ligation blocks or severs the tubes but leaves them in place. A bisalp takes them out entirely. This matters for two reasons: effectiveness and cancer prevention.
Tubal ligation has a 10-year failure rate that, while low, is real. Partial salpingectomy techniques fail at a rate of roughly 1.2 per 1,000 cases. A complete bilateral salpingectomy, by contrast, is so effective that its specific failure rate hasn’t been formally established in the medical literature. A 2022 systematic review found only four reported cases of spontaneous pregnancy after a total bilateral salpingectomy in all of published medicine, and at least one of those turned out to involve an incomplete removal where a tubal remnant was left behind.
The tradeoff is that a bisalp takes somewhat longer in the operating room. In one randomized trial comparing the two procedures done during cesarean delivery, the sterilization portion averaged about 18 minutes for salpingectomy versus 7 minutes for tubal ligation. For a standalone laparoscopic procedure, the difference is generally less noticeable.
Ovarian Cancer Risk Reduction
One of the biggest reasons bisalp has grown in popularity is its connection to ovarian cancer prevention. Research now shows that many cases of epithelial ovarian cancer, the most common and deadly type, actually originate in the fallopian tubes rather than the ovaries themselves. Removing the tubes eliminates that starting point.
Salpingectomy has been associated with an approximately 80% reduction in ovarian cancer risk. If widely adopted, researchers estimate it could reduce ovarian cancer deaths in the United States by around 15%. This cancer-prevention benefit is a major reason many gynecologists now recommend bisalp over tubal ligation for patients seeking permanent sterilization.
Effects on Hormones and Periods
Removing the fallopian tubes does not affect your hormone levels. The ovaries, which produce estrogen and progesterone, are left completely intact during a bisalp. Studies comparing hormone markers before and after the procedure show no differences at 3 and 9 months post-surgery. Your ovaries continue to release eggs on their normal cycle; those eggs simply get absorbed by the body instead of traveling through a tube.
This also means a bisalp does not trigger early menopause. You’ll continue having periods as usual. A large study using data from the U.S. Collaborative Review of Sterilization found that women who had undergone tubal sterilization were no more likely than other women to experience menstrual abnormalities. The concept of a “post-sterilization syndrome” involving irregular or heavier periods has been debated for decades, but the evidence consistently fails to support it. If anything, some women in the study reported slightly decreased bleeding and less menstrual pain afterward.
Recovery Timeline
Because the laparoscopic version uses only small incisions, recovery is relatively quick. Most people take about one to two weeks off from work, though those with desk jobs sometimes return sooner. Physical activity is gradually reintroduced, with heavy lifting typically restricted for the first two to four weeks. Soreness around the incision sites and some bloating from the gas used during surgery are the most common complaints in the first few days. Shoulder pain from residual gas irritating the diaphragm is also normal and resolves on its own.
Insurance Coverage Under the ACA
The Affordable Care Act requires most health insurance plans to cover FDA-approved sterilization procedures for women with no out-of-pocket cost. Bilateral salpingectomy falls under this requirement. However, navigating coverage can still be tricky in practice.
Your plan can require that the surgery be performed by an in-network provider to qualify for zero cost-sharing. If no in-network provider is available, your insurer must cover an out-of-network provider at no cost to you, though you may need to file an appeal. Billing codes matter: the procedure should be filed with the correct preventive service code and the diagnosis code Z30.2 for sterilization. Incorrect coding is one of the most common reasons claims get denied, so it’s worth confirming with both your surgeon’s office and your insurance company before the procedure that everything is coded properly. If your insurer initially denies coverage, the National Women’s Law Center recommends citing the ACA’s sterilization coverage requirement and asking about their waiver process.
Who Gets a Bisalp
Bisalp is chosen by people who are certain they don’t want biological children (or additional children) and want a permanent, highly reliable option. It’s also recommended for people at elevated risk of ovarian cancer, including those with BRCA gene mutations, because of the significant cancer risk reduction. Some people choose it specifically because it’s more effective than tubal ligation and carries the added cancer-prevention benefit.
Because the procedure is permanent and not reliably reversible, it’s not appropriate for anyone who thinks they might want to become pregnant in the future. While IVF remains technically possible after a bisalp since the ovaries still produce eggs, natural conception is effectively eliminated.