Pregnancy after tubal sterilization with silicone rubber band and spring clip application

Long-term risk of ectopic pregnancy varies by method of tubal sterilization: a whole-population study

OBJECTIVE

To evaluate the risk of ectopic pregnancy (EP) associated with different methods of tubal sterilization.

DESIGN

Population-based retrospective cohort study.

SETTING

Hospitals in Western Australia.

PATIENT(S)

All women aged 18-44 years undergoing tubal sterilization between 1990 and 2010 at Western Australian hospitals (n = 44,829).

INTERVENTION(S)

Data on tubal sterilization were extracted from hospital records.

MAIN OUTCOME MEASURE(S)

Long-term risk of EP.

RESULT(S)

There were 89 EPs recorded during the observation period in women previously sterilized. The 10-year and 15-year cumulative probability of EP for all methods of tubal sterilization were 2.4/1,000 and 2.9/1,000 procedures, respectively. The 10-year cumulative probability of EP was 3.5 times higher in women sterilized before the age of 28 years than in those sterilized after the age of 33 years. An increased risk of EP existed in women who received laparoscopic partial salpingectomy (adjusted hazard ratio = 14.57, 95% confidence interval 3.50-60.60) and electrodestruction (adjusted hazard ratio = 5.65, 95% confidence interval 2.38-13.40), compared with those who had laparoscopic unspecified destruction of fallopian tubes.

CONCLUSION(S)

Women undergoing tubal sterilization at a young age are at particular risk for subsequent EP. The risk among younger women doubled between 5 and 15 years after sterilization. Laparoscopic electrodestruction and partial salpingectomy carried the highest risk of EP.

Office hysteroscopic sterilization compared with laparoscopic sterilization: A critical cost analysis

STUDY OBJECTIVE

To evaluate the actual cost difference in performing Essure hysteroscopic sterilization in the office compared with ambulatory surgery using laparoscopic sterilization in the operating room.

DESIGN

Cost-comparison analysis (Canadian Task Force classification III).

SETTING

University hospital and affiliated outpatient office.

INTERVENTIONS

Hysteroscopic placement of Essure device in an office setting and laparoscopic tubal ligation for permanent sterilization.

MEASUREMENTS AND MAIN RESULTS

The various costs associated with the two procedures at our institution were compiled, and a direct cost comparison was made. We used actual institutional costs of the procedures, not billing or reimbursement. We found laparoscopic tubal ligations to cost 3449 dollars compared with hysteroscopic placement of the Essure device that costs 1374 dollars yielding a 2075 dollars difference between the procedures.

CONCLUSION

In our institution and in our experience, office-hysteroscopic placement of the Essure device is a more cost-effective method than laparoscopic tubal ligation.

Essure®: a new device for hysteroscopic tubal sterilization in an outpatient setting

OBJECTIVE

To evaluate the results of hysteroscopic placement of an intratubal device for permanent birth control in 85 women in an outpatient setting.

DESIGN

Prospective, observational study.

SETTING

Private university hospital.

PATIENT(S)

Eighty-five premenopausal women who asked for tubal sterilization by hysteroscopy between July 2002 and July 2003.

INTERVENTION(S)

Hysteroscopic placement of titanium-dacron intratubal devices in an outpatient setting.

MAIN OUTCOME MEASURE(S)

Procedure feasibility without anesthesia, success rate of device implantation, patient satisfaction, and confirmation of correct placement.

RESULT(S)

Successful placement was achieved in 81 patients (95%). Mean time elapsed between the start of hysteroscopy, placement of devices, and removal of optics was 9 minutes (range, 1-35 minutes). No intraoperative or postoperative complications were detected. Of 81 patients, 75 (93%) had abdominal x-ray performed at the third month; bilateral correct placement was confirmed in all of them.

CONCLUSION(S)

Essure is a safe, effective, and minimally aggressive procedure with satisfactory patient acceptance that does not require anesthesia or hospitalization. It seems to be a good alternative to laparoscopic tubal sterilization.