Abstract

PIP: Current methods of tubal sterilization include transabdominal and transvaginal coagulation, transuterine tubal ligation, surgical procedures, and mechanical occlusion techniques, conventional unipolar electrocoagulation (failure rate 1-3%) is increasingly replaced by bipolar coagulation (failure rate 1.6%) to avoid burns to the intestine or skin, with thermocoagulation as a 3rd alternative. Surgical procedures, particularly the Pomeroy method, are well suited for developing countries, where electrical current or insufflation gas are often not available or too costly. Mechanical occlusion techniques with clips, elastic silastic rings, or intratubal devices, still in the experimental stage, have the advantage of possible reversibility. In 1975 in the U.S., of 500,000 female sterilizations, 60% were surgical and 40% laparoscopic, the latter rate considered high in view of the recent introduction of the method. The laparoscopy complication rate is obviously closely associated with the skill and experience of the operator, and has decreased rapidly in recent years. Laparoscopy-related complications include damage to large vessels and intestine during introduction of the instrument, gas embolisms, bleeding from the mesosalpinx or abdomen, and burns on intestine, bladder, or stomach. Heart and circulatory accidents sometimes occur during insufflation, when the pneumoperitoneum is introduced. The mortality rate of laparoscopy is in the same range as the "pill" and the IUD, and far lower than that of tubal ligation, hysterectomy, or birth. As aftereffects, extrauterine pregnancies, irregular menstruation, dysmenorrhea, and amenorrhea have been reported. Recent investigations have shown that only about 1-5% of sterilized women later regret the operation. Conversely, an inquiry in Dohrn revealed that after sterilization, 55% of the women experienced a better outlook on life, 46% improvements in family life, and 66% better sexual relations. Recently "open laparoscopy" (through the open abdomen) or "optical laparoscopy" (with a viewer attached to the instrument) is being performed to avoid accidents during instrument insertion. Minilaparotomies and hysterectomy are other alternatives. There are advantages an ddisadvantages for all 3 of the major tubal sterilization procedures - laparoscopy, culdotomy, and minilaparotomies - and the procedure should be determined on an individual basis. In general, female sterilization is considered to be irreversible.