Sterilization: a comparative review

Abstract

Publications relating to surgical procedures for sterilization have been reviewed, and the incidences of complications and subsequent pregnancies compared. Laparoscopic sterilization has the lowest incidence of complication, the morbidity rate being lower than that of laparotomy sterilization or hysterectomy, and the mortality rate lower than that of a single pregnancy or taking oral contraceptives for 1 year.

PIP: A review of recent literature on female sterilization procedures and outcomes led to the conclusion that laparoscopic sterilization was associated with lower complication rates than other procedures. There were no large scale studies comparing sterilization procedures; therefore, comparable statistics were obtained by combining the results of all suitable small scale studies reported in English language publications from 1960-1978. Compared techniques were laparoscopy, laparotomy, colpotomy, and hysterectomy. Major findings were 1) hysterectomy, regardless of the timing of the operation, was associated with a higher complication and mortality risk than any other sterilization procedure; 2) colpotomy was associated with a high complication rate and a high rate of failure to complete the operation; 3) laparoscopy was associated with a lower incidence of mortality, morbidity, and subsequent pregnancy than laparotomy; and 4) the risk of mortality associated with laparoscopic sterilization was lower than the mortality risk associated with a single pregnancy or with 1 year of oral contraceptive usage. For interval abdominal hysterectomy the mortality risk was 1.65/1000 procedures and the major morbidity risk was 33.39/1000 procedures. The respective rates were 0.28 and 18.40 for laparotomy sterilization, 0.07 and 1.89 for interval laparoscopic sterilization, and 0.00 and 21.32 for viginal sterilization. Failure rates for interval laparotomy, interval laparoscopy, and for vaginal sterilization were 7.08, 4.93, and 4.87/1000 procedures, respectively. Findings are presented in tabular form.