Abstract

PIP: Voluntary surgical sterilization offers the advantages over other methods of being a once only procedure which eliminates the risk of unwanted pregnancy, does not entail regular checkups or require supplies or sustained motivation, and has a small risk of complication when properly performed. Counseling is particularly important in the case of voluntary sterilization and should include discussion of all contraceptive methods including their risks and benefits, emphasis on the permanence of the procedure and the small risk of failure, and discussion of all aspects of sterilization procedures and types of anesthetic available. Voluntary informed consent should be ensured and an adequate time interval should be allowed after counseling. The sterilizlation decision should not be made at a time of emotional stress. Both male and female sterilization can be carried out under local anesthetic with mild sedative, but when a general anesthetic is given the patient should be in the hands of a health professional trained in anesthesia and should fast for at least 6 hours preoperatively. Intubation and positive-pressure ventilation are recommended, and emergency resuscitation equipment must be available. Anesthesia is the most important cause of morbidity and mortality associated with female sterilization. Vasectomy is a simple operation performed under local anesthetic as an outpatient procedure, and should have no risk of mortality when properly done. Another method should be used until approximately 15 ejaculations have taken place. Laparoscopic female sterilization requires costly and sophisticated equipment and training and is best carried out in hospitals with specialized equipment and staff. Complications, although uncommon, may require experienced surgical intervention. The chance of puncture of abdominal viscera or blood vessels may be minimized with the new technique of open laparoscopy. Minilaparotomy is relatively simple, has less sophisticated training and equipment requirements, and is suggested for most family planning programs. Both procedures can be carried out under local or general anesthetic, and women can be discharged the same day. Vaginal approaches to the tubes are associated with more complications and are not frequently used. Studies are underway to assess the various occluding techniques; at present the Pomeroy technique is recommended for minilaps and rings and clips for laparoscopy. The most important late complication of female sterilization is pregnancy, which may be ectopic.