Laparoscopic Sterilisation in Camps in Rural India

Abstract

Since 1973 laparoscopic sterilization under local anesthesia has been available as a day case procedure at preplanned camps to rural women in India. This study attempted to evaluate the safety and feasibility of this approach through analysis of the records of the 9066 women who were sterilized at camps between January 1 1973 and June 30 1983. During this period the mean age of sterilization acceptors gradually decreased from 33.4 years to 27.4 years and mean parity dropped from 4.4 to 3.2. 93.2% of cases involved interval sterilization. There has been a trend away from tubal diathermy and toward greater use of rings and clips. The time from injection of the local anesthetic to completion of surgeryu averaged 14 minutes. No deaths or injuries to a major vessel occurred in this series. Surgical difficulties were encountered in 7.9% of subjects and laparotomy was required in .5%. The overall complication rate was 5.3% which is comparable to that observed in other series and commendable considering the rather inadequate camp facilities. Perforation of the uterus was the most frequent complication (1.2%). There were 5 pregnancies in this series all occurring within 1 yearof the procedure. The Falope ring had been used in 4 of these cases. No ectopic pregnancy was reported. The failure rate in this series was .60/100 woman-years. It is concluded laparoscopic sterilization in rural camps has been an acceptable and useful contribution to fertility control in the developing world. The authors consider this approach to be cheaper and more effective than reversible methods.