Failures of laparoscopy sterilization

Abstract

Female sterilization by laparoscopy has become widely accepted throughout the United States and Europe. The failure rate of this procedure is still speculative. In the course of 4200 operative sterilization, 32 failures have been identified and 31 of these have been subsequently evaluated. The most common finding was inadequate or superficial fulguration and resection. Operative errors such as round ligament fulguration were also more common than expected.

PIP: The failure rate of laparoscopic sterilization in 4200 patients aged 13-49 years is reported and suggestion are made to avoid such failures. Patients were treated at the Laparoscopy Sterilization Clinic of the Johns Hopkins Hospital over a 5-year period. 62 surgeons and about 250 visiting physicians being trained in laparoscopic technique participated. About 85% of the operations were on an outpatient basis. Indications for patients under age 18 were severe mental retardation. In the 1st 1000 cases the 2-incision method was used and a single large segment of each tube removed. For the 2nd 1000 cases a single inclision was used and only a small segment of tube removed. For the last 2200 patients a single incision was used but the proximal stump of each tube was fulgurated again. This was called the "3-burn-technique," it is the present preferred method. Of the first group 91% have been contacted and 5 failures have been recorded in a 66-month period. 3 were surgical failures and 2 were operative errors in which the round ligaments had been ligated. Among the 2nd 1000 there were 17 failures. In 12, inadequate fulguration and resection had been done, in 4, utero-overian ligament had been resected; 1 patient refused postoperative evaluation. The final group, with a 2nd fulguration of the proximal stump and wider separation of the stumps, had 10 failures in 2200 cases. There were 4 cases of unilateral incomplete section, 2 of ectopic gestation, and 3 resections of round ligaments. Of the total of 32 failures 23 occurred in the 1st 5 months after surgery. Since the adoption of the 3-burn-technique, only 6 failures have occurred when the tubes were correctly identified. In 2 of these ectopic gestation occurred. Only 2 patients in this group required laparotomy to control hemorrhage. Longer follow-up intervals will be needed before final figures are available.