Techniques for the interruption of tubal patency for female sterilisation

Nardin JM, Kulier R, Boulvain M

Bookmark this:

more ...

Email this page

Summary

Effective techniques for tubal sterilisation (blocking the fallopian tubes) include cutting, tying, clips, rings and electric current, but their comparative effectiveness is not clear

Tubal sterilisation prevents pregnancy by stopping the woman's unfertilised egg (ovum) passing through the fallopian tubes where it can be fertilised by sperm. Techniques to close the tubes include cutting and tying, blocking mechanically by using clips or rings, and the use of an electric current to coagulate (form a hard mass) in the tubes. The review of trials found that all techniques are effective in preventing pregnancy, with few adverse effects. There is too little evidence to which technique is most effective. Pregnancy after tubal sterilisation is less likely if an experienced practitioner has performed the procedure.

This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2010 Issue 1, Copyright © 2010 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This record should be cited as: Nardin JM, Kulier R, Boulvain M. Techniques for the interruption of tubal patency for female sterilisation. Cochrane Database of Systematic Reviews 2002, Issue 4. Art. No.: CD003034. DOI: 10.1002/14651858.CD003034.

This version first published online: October 21. 2002

Abstract

Background

Female sterilization is the most popular contraceptive method worldwide. Several techniques are described in the literature, however only few of them are commonly used and properly evaluated.

Objectives

To compare the different tubal occlusion techniques in terms of major and minor morbidity, failure rates (pregnancies), technical failures and difficulties and women's and surgeons' views.

Search strategy

The Cochrane Controlled Trials Register has been searched. A search of the reference lists of identified trials was performed. An additional MEDLINE search was done using an Internet search service Pub Med.

Selection criteria

All randomized controlled trials comparing different techniques for tubal sterilization, regardless of the way of entry in the abdominal cavity or the method of anesthesia.

Data collection and analysis

Trials under consideration were evaluated for methodological quality and appropriateness for inclusion. Nine relevant studies were included and the results were stratified in five groups: tubal ring versus clip, modified Pomeroy versus electrocoagulation, tubal ring versus electrocoagulation, modified Pomeroy versus Filshie clip and Hulka versus Filshie clip. Results are reported as odds ratio for dichotomous outcomes and weighted mean differences for continuous outcomes.

Main results

Tubal ring versus clip: Minor morbidity was higher in the ring group (Peto OR 2.15; 95% CI 1.22, 3.78). Technical difficulties were found less frequent in the clip group ( Peto OR 3.87; 95% CI 1.90, 7.89). There was no difference in failure rates between the two groups (Peto OR 0.70; 95% CI 0.28, 1.76).
Pomeroy versus electrocoagulation: Women undergoing modified Pomeroy technique had higher major morbidity than with electrocoagulation technique (Peto OR 2.87; 95% CI 1.13, 7.25). Postoperative pain was more frequent in the Pomeroy group (Peto OR 3.85; 95% CI 2.91, 5.10).
Tubal ring versus electrocoagulation: Post operative pain was more frequently reported in the tubal ring group. No pregnancies were reported.
Pomeroy versus Filshie clip: In the trial comparing the two interventions only one pregnancy was reported in the Pomeroy group after follow-up for 24 months.
No differences were found when comparing Hulka versus Filshie clip in the only study that compared these two devices (Toplis 1988).

Authors' conclusions

Electrocoagulation was associated with less morbidity when compared with tubal ring and other methods. However the risk of burns to the small bowel might be a serious criticism of the approach. The small sample size and the relative short period of follow-up in these studies limited the power to show clinical or statistical differences for rare outcomes such as failure rates. Aspects such as training, costs and maintenance of the equipment may be important factors in deciding which method to choose.

top of page | contact us | about this site | disclaimer | privacy