The ineffectiveness of tubal surgery in rendering a woman sterile is discussed in this review of surgical procedures used for tubal ligation and/or excision. The following methods have been used: tubal ligation, section and resection of tubes between 2 ligatures, resection of tubes between 2 ligatures with burial of the uterine end, cauterization of sectioned tubes, bilateral salpingectomy, and resection of interstitial canal by removal of a wedge-shaped piece of uterine cornu. In a retrospective look at tubal ligation procedures performed at Johns Hopkins, it was noted that 14 of 23 tubal ligations could be traced for follow-up, and of these 5 were over 40 years old at time of operation, but 2 of the remaining 9 cases had become pregnant after surgery. A case history of a patient whose tubes were sectioned and resectioned showed that she too became pregnant after surgery. Hence, until more satisfactory methods are devised, extirpation of the tubes together with excision of a wedge of uterine cornu is the simplest and most effective tubal sterilization procedure.