Late sequelae following laparoscopic sterilization employing electrocoagulation and tubal ring techniques: a comparative study

Abstract

Data on 211 consecutive laparoscopic sterilized women were compared. Half the patients were sterilized using unipolar electrocoagulation and the rest had tubal rings. The period of observation was 21-50 months, median 36.5 months. Four failures were observed, median 15 months after the operation. Pregnancy rates were 0.32 per 100 woman years using electrocoagulation and 1.02 using tubal rings. A total of 11% had experienced low abdominal pain and 4% dyspareunia. Menstrual pattern changes were reported by 31% in the electrocoagulation group and 43% in the tubal ring group. The rates of late sequelae were statistically significant independent of the technique employed.

PIP: 2 groups of consecutive patients who were sterilized either by laparoscopic tubal diathermy or by laparoscopic application of tubal rings were reviewed. Particular reference was paid to the evaluation of late occurring problems such as safety, low abdominal pain, dyspareunia, and bleeding pattern changes. The total of 285 healthy women were sterilized over the 1978-82 period. All the operations were performed electively at the patient's request, and they were informed that the sterilization was an irreversible procedure. The laparoscopic sterilizations were performed in essentially the same manner in both groups, using a Benveniste uterine guide for better stabilization and manipulation of the uterus. The median observation time was 36.5 months (range 21-50 months). At the time of admission, 28% were pregnant, all in the 1st trimester. These women underwent sterilization immediately after induced abortion. The study patients were selected to receive different occlusion techniques with respect to the time period they were sterilized. In Group 1 (electrocoagulation), a total of 106 (50.2%) women sterilized consecutively from 1978-80 had both fallopian tubes unipolarly electrocoagulated twice without tubal division. In Group 2 (tubal ring), a total of 105 (49.8%) women sterilized consecutively from 1980-82 had both fallopian tubes ligated by means of silastic band application approximately 2 1/2 cm from the uterine corner. There was no statistically significant difference between the 2 groups of women in terms of median age, age-distribution, number and distribution of induced abortions, and number of children prior to sterilization. In the electrocoagulation group, 1 woman became pregnant after the sterilization. The pregnancy occurred 21 months after the operation. The reason for the failure was not established as the pregnancy was ectopic and had ruptured. In the tubal ring group, 3 women became pregnant after the sterilization. The failures occurred from 6-23 months after the operation. In 2 cases the tubal rings were found on the round ligaments or completely missing at 1 salpinx. In the 3rd case, both rings were situated in the correct position. 13.2% of the electrocoagulation group reported low abdominal pain and 6.6% dysparunia as new symptoms appearing after the sterilization. The corresponding rates in the tubal ring group were 8.6% and 1.9%. These differences were not statistically significant, and there also was no difference between the rates in the decades. Changes in bleeding pattern following the sterilization procedure were equally related to age and reported by 33 women in the electrocoagulation group and 45 in the tubal ring group. It is concluded that the rates of late sequelae following laparoscopic sterilization using unipolar electrocoagulation or ring application to the fallopian tubes are independent of the method used, but combining these data with the results of other studies, the ring method is found to be more suitable because of fewer ectopic pregnancies and a greater potential for reversal.