Reliability and reversibility of female sterilisation.

Abstract

The technique of laparoscopy has become popular in Britain, requiring effective methods of occluding the tubes. High-frequency unipolar current, bipolar current and thermocoagulation are all very destructive procedures. A surgeon attempting reversal after electrocoagulation may find extensive tissue damage or other complications such as contact burns; when equally effecitve procedures are available, it becomes difficult to justify continued use of the method. A popular alternative is the variety of occlusive devices. The British Rocket clip has a failure rate of only about 2/1000, it destroys only about .3 cm of tube, and the applicator has a safety catch mechanism allowing removal before final closure if placement is in question. The silicone (Falope) ring causes infarction and obliteration of the lumen of the 2-3 cm of tube ensnared in the ring. Although the need to draw a loop of tube into the instrument delivering the ring has resulted in injuries to the tube and mesosalpinx, this has occurred less frequently with experience. Successful reversal after the use of these devices has been reported. Any study of reliability of a method of sterilization should consider the following variables: operator experience, the timing of the procedure, the route and technique used, the means of achieving occlusion, the site of tube selected, the method of analyzing results, and an account of the time of exposure when expressing failure rates. Pregnancies are most likely in the first 2 years, ectopic pregnancies are most likely with electrocoagulation, and 12-month life table pregnancy rates on data from 60 centers have shown identical rates of 2/1000 for laparoscopy and minilaparotomy. For both closure and reversibility the narrowest part of the tube is the best choice, and minilaparotomy using a Pomeroy operation or a device would have advantages over laparoscopy in underdeveloped societies. Now that devices have proved as effective as electrocoagulation, or surgical occlusion, they can be recommended by any route with preference give to those destroying the least tissue.