Which are the Most Safe and Effective Female Sterilization Surgeries?
BACKGROUND AND PURPOSE:
No RCTs exist to compare traditional operative sterilization procedures to the newer hysteroscopic approach
The Finnish Office of Health started a systematic review of hysteroscopic sterilization in 2010, including high quality registries that can provide data on various tubal sterilization techniques
Jokinen et al. (BJOG, 2017) aimed to compare the safety and long term results between laparoscopic (Filshie clip), mini-laparotomy (Pomroy) and hysteroscopic (Essure) approaches
Data was compared from 16,272 female sterilizations to measure failure rate of each type of sterilization
Outcome measures included
All pregnancies after sterilization (births, miscarriages, terminations of pregnancy, and ectopic pregnancies)
Operations (repeat sterilizations, other hysteroscopic and laparoscopic procedures, hysterectomies, and re-operations for a complication)
There was no significant difference in all spontaneous pregnancies between the groups
In total, 1394 selected operations were identified after primary sterilization
All reported operations were more frequent in the hysteroscopy group but only remained significant between the Pomeroy and hysteroscopy when re-sterilizations were removed group with a risk ratio of 0.48 (95% CI 0.43–0.54)
Re-sterilizations were most frequent among the hysteroscopic group with a risk ratio between the clip and hysteroscopy group of 0.51 (95% CI 0.40-0.65), and 0.13 (95% CI 0.10-0.17) between the Pomeroy and hysteroscopy group
Patients undergoing hysteroscopic or laparoscopic sterilization have a similar risk of unintended pregnancy
All sterilizations are safe, and risk of re-operations because of complications is low
Women who have had hysteroscopic sterilization have a higher risk of undergoing re-sterilization compared with patients undergoing laparoscopic sterilization
Hysteroscopic sterilization has become the most common surgical sterilization procedure
Rate of surgical sterilization has dropped due to delayed childbearing and increased use of IUDs, specifically levonorgestrel intrauterine system (LNG-IUS).
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This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
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presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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