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Use of multiple clips for tubal occlusion in interval laparoscopic sterilization: circumstances and consequences.

Abstract：

:The use of multiple clips for the occlusion of the Fallopian tubes has been reported in interval laparoscopic sterilization, but the circumstances leading to the performance of the multiple-clip procedure and its effects on safety and efficacy have not been carefully studied. A data set from international multi-center clinical trials of Filshie clips and Wolf (Hulka) clips was used to examine the possible reasons for performing this procedure for 102 women. Their complications, complaints, and surgical and post-surgical events before discharge and during one month of follow-up were compared with those of the 408 women whose tubes were occluded by single clip. Results indicate that multiple clips were most often used when surgical difficulties (and to a much lesser degree, tubal and/or mesosalpingeal injury) were encountered during the sterilization procedure. No increased risk of short-term complications or complaints (including pelvic pain) was found at one-month follow-up for those patients who received multiple clips. :Occlusion of the fallopian tubes by use of clips has been widely practiced. In some cases the use of multiple clips has been reported, but the reasons for selecting the multi-clip method over the single-clip procedure are not clear. In this retrospective study, data from international records on clip usage was examined for possible answers for selecting single versus multiple clips. Also reported are the complications, complaints, and surgical and post-surgical events. These studies noted that laparoscopic sterilization was performed and that either the Filshie clips or Wolf (Hulka) clips were used in 17 international centers. 79 (3.3%) of 2366 women noted in the records who had the Filshie clip inserted also had multiple clips inserted. With regard to the Wolf clip, 23 (3.7%) of 623 women also had multiple clips inserted. In this study, 102 women occluded by multiple clips were matched with 4 women each (for a total of 408 women) who had a single-clip occlusion procedure. Surgical difficulties in the multiple-clip group were evident. In 72 women (70.6%), surgeons had difficulties in occluding the tubes; in 11 women (10.8%), in grasping the tubes; and in 5 women (4.9%), in finding the tubes. After comparing multiple- and single-clip patients, no significant differences could be identified. Difficulties during the laparoscopic sterilization procedure tended to be the main reason for selection of multiple clips. No increased risk in short-term complications or complaints were reported.

journal_name

Contraception

journal_title

Contraception

authors

Chi IC

doi

10.1016/0010-7824(94)90058-2

subject

Has Abstract

pub_date

1994-11-01 00:00:00

pages

409-16

issue

eissn

0010-7824

issn

1879-0518

pii

0010-7824(94)90058-2

journal_volume

pub_type

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Use of multiple clips for tubal occlusion in interval laparoscopic sterilization: circumstances and consequences.