Puerperal laparoscopic sterilization

Abstract

One hundred sixty-eight cases of puerperal laparoscopic sterilization are presented. The operative technique, complications, and morbidity are discussed. Intraoperative and postoperative complications occurred in six patients (3.6%). Operative time (21 minutes) and postoperative stay (2.4 days) compared favorably with those of the concurrent series of 148 open postpartum ligations. It was concluded that puerperal laparoscopic sterilization in expert hands is a safe, viable alternative to laparotomy.

PIP: In addition to a tabular presentation summarizing the published literature pertaining to puerperal laparoscopic sterilization, a study of 168 such procedures, performed at 3 hospitals, is presented. During the same period, 148 open tubal ligations were performed: 64 Pomeroy, 24 Irving, and 60 Irving with appendectomy. All sterilizations were performed within 72 hours of delivery. The average operating time was 21 minutes for laparoscopic sterilization (range, 7-50 minutes). An average of 25 minutes was found for the open tubal ligation series, and an average of 37 minutes was required when appendectomy accompanied the tubal ligation procedure. The average postoperative stay was 2.4 days for the laparoscopic procedure vs. 3.1 days for all open tubal ligations, 4.7 days for open tubal ligations plus appendectomy, and 2.8 days for mini-laparotomies. Operative and early postoperative complications occurred during the laparoscopic series in 6 patients (3.6%). These complications were attributed to technical pneumoperitoneum establishment difficulties, broad ligament bleeding, postpartum salpingitis, and postpartum endometritis. The puerperal laparoscopic sterilization procedure compares favorably with the other open tubal ligation and mini-laparotomy procedures; however, it is cautioned that the postpartum (within 72 hours) procedure has greater technical difficulties compared with interval methods, and only highly trained professionals with abundant experience should attempt puerperal procedures. Though too early to make definitive statements, it seems from this and other published studies that the risk and morbidity of puerperium laparoscopic sterilization are no greater than with any other puerperal procedure for sterilization. It is indicated for women with preexisting systemic diseases such as diabetes, epilepsy, and hypertension or for women with previous history of abdominal surgery.