Abstract
BackgroundSurgical sterilization is a common method of contraception. There have been few studies evaluating the effect of obesity on procedural complications with either laparoscopic or hysteroscopic methods of sterilization. The purpose of this study was to compare the incidence of intraoperative complications of hysteroscopic tubal occlusion with laparoscopic tubal ligation among obese and nonobese women.MethodsThis retrospective cohort study compared women undergoing interval laparoscopic or hysteroscopic sterilization in the operating room between September 2009 and December 2011 at a single hospital. Serious complications included: unintended surgery, uterine perforation, anaphylaxis, blood transfusion, infection requiring antibiotics, hospital admission, fluid overload, myocardial infarction, and venous thromboembolism. Post-operative events included: nausea/vomiting, doctor evaluation or additional pain medication required in the recovery room, and emergency department visit within 2 weeks of surgery. The association between sterilization type and incidence of complications was examined overall, separately by BMI group, and also among patients who received general anesthesia.ResultsA total of 433 laparoscopic and 277 hysteroscopic procedures were reviewed. The BMI distribution of the sample was 35 % normal weight, 31 % overweight, and 34 % obese which is comparable to the general US female population. No life-threatening events were identified. Serious complications were similar with 20 (4.6 %) in the laparoscopic group and 11 (4.0 %) in the hysteroscopic group (p = 0.9). The most common serious complications were bleeding from the tube, cervical laceration, and uterine perforation. Although not statistically significant, women with a BMI of 30 or greater had only 1 (1 %) serious complication in the hysteroscopic group compared to 7 (5.2 %) in the laparoscopic group. Postoperative events were increased in the laparoscopic group (16.2 %) compared to the hysteroscopic group (6.9 %), especially among overweight and obese women (p <0.01). Failure to complete the intended bilateral occlusion occurred for 14 women in the hysteroscopic group compared to just one woman in the laparoscopic group (p <0.001).ConclusionBoth laparoscopic and hysteroscopic tubal sterilization are safe with few serious complications based on these data. No cases of laparotomy, blood transfusion, or life-threatening events were identified. There was no difference in serious complication rate by sterilization method. Overweight and obese women were no more likely to experience a serious complication with either method than women with a BMI <25. There were fewer postoperative events (p <0.01) with hysteroscopic sterilization, but far fewer failed laparoscopic procedures (p <0.001). These study findings can be used to enhance sterilization counseling.
Highlights
Surgical sterilization is a common method of contraception
Shepherd et al Contraception and Reproductive Medicine (2016) 1:1 (Continued from previous page). Both laparoscopic and hysteroscopic tubal sterilization are safe with few serious complications based on these data
There was no difference in serious complication rate by sterilization method
Summary
Surgical sterilization is a common method of contraception. There have been few studies evaluating the effect of obesity on procedural complications with either laparoscopic or hysteroscopic methods of sterilization. Surgical sterilization is one of the most commonly used methods of contraception for women in the United States with over 600,000 procedures performed each year [1]. The landmark United States Collaborative Review of Sterilization (CREST) study analyzed complication rates among 9,475 women undergoing interval laparoscopic tubal ligation (LTL) from 1978 to 1987. Complications, defined as performance of an unintended major surgery at the time of sterilization, occurred in 0.9 per 100 women [2]. This strict definition of complications did not include post-operative events that a patient might factor into her decision to proceed with an elective sterilization. A British study which defined complications broadly including vasovagal reactions, cervical tear and bleeding, tubal perforation, uterine perforation, postoperative pain, and nausea/vomiting found that outpatient HS was associated with fewer complications than operating room LTL (11 % vs. 27 %) [3]
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