Female sterilisation--no more tubal coagulation.

Abstract

The use of clips was discussed as a simple method of sterilization in the lead articles of April 12 (p. 1037) and May 10 (p. 1154). We have used the Hulka-Clemens clips as a method of choice for laparoscopic sterilization in Westminster Hospital since 1977, and have been impressed with their operative safety. However, recently we have had an alarming number of pregnancies occurring after clip sterilizations, and so have analyzed our figures. During the years April 1977-April 1980, 328 laparoscopic sterilizations were performed in this unit. Of these women, 8 to date have become pregnant, and showed tubal patency on hysterosalpingogram. All 9 failures occurred following use of the Hulka-Clemens clips. This gives an overall failure rate of 2.1% and a failure rate for clip sterilization estimated at 3%. In none of the failures was the sterilization performed with a termination or in the puerperium. In all the cases except 1, the clips were applied by a consultant or senior registrar. All the patients had a subsequent salpingectomy, and the tubes were inspected macroscopically and microscopically. In all cases, the clips were found to be properly applied across the fallopian tube and fully closed. Nevertheless, on microscopy, each case had a patent lumen present in at least 1 tube. We are unable to identify any elements in technique of application that could account for these failures; in 2 of the cases which failed, 2 Hulka-Clemens clips had been applied to each tube. We feel that these figures should be publicized, as strong views have been expressed in recent months condemning tubal diathermy as a sterilization method, and advocating the use of clips or rings because of easier reversibility. In our practice, clip sterilization is less safe than oral contraception or the IUD. We would be interested in hearing about similar failure rates in other units.