Elsevier

Obstetrics & Gynecology

Volume 96, Issue 6, December 2000, Pages 997-1002
Obstetrics & Gynecology

Complications of interval laparoscopic tubal sterilization: findings from the United States collaborative review of sterilization

https://doi.org/10.1016/S0029-7844(00)01082-6Get rights and content

Abstract

Objective: To estimate the risk of intraoperative or postoperative complications for interval laparoscopic tubal sterilizations.

Methods: We used a prospective, multicenter cohort study of 9475 women who had interval laparoscopic tubal sterilization to calculate the rates of intraoperative or postoperative complications. The relative safety of various methods was assessed by calculating overall complication rates for each major method of tubal occlusion. Method-related complication rates also were calculated and included only complications attributable to a method of occlusion. We used logistic regression to identify independent predictors of one or more complications.

Results: When we used a more restrictive definition of unintended major surgery, the overall rate of complications went from 1.6 to 0.9 per 100 procedures. There was one life-threatening event and there were no deaths. Complications rates for each of the four major methods of tubal occlusion ranged from 1.17 to 1.95, with no significant differences between them. When complication rates were calculated, the spring clip method had the lowest method-related complication rate (0.47 per 100 procedures), although it was not significantly different from the others. In adjusted analysis, diabetes mellitus (adjusted odds ratio [OR] 4.5; 95% confidence interval [CI] 2.3, 8.8), general anesthesia (OR 3.2; CI 1.6, 6.6), previous abdominal or pelvic surgery (OR 2.0; CI 1.4, 2.9), and obesity (OR 1.7; CI 1.2, 2.6) were independent predictors of one or more complications.

Conclusion: Interval laparoscopic sterilization generally is a safe procedure; serious morbidity is rare.

Section snippets

Materials and methods

The methods of the United States Collaborative Review of Sterilization were reported.5 Eligible women were 18–44 years old who were scheduled for tubal sterilizations in 15 participating institutions in nine cities from 1978 to 1987. Trained interviewers attempted to contact all eligible women to request participation. Approval for this study was granted by the institutional review board at each institution and participants signed informed consent forms. Among 12,138 women enrolled, the current

Results

Most participants were white and 25 to 34 years old. Thirty-four percent were black. Nearly 80% had at least high school educations (Table 1) and only 3.5% were nulliparous.

One hundred fifty-three women had at least one standard complication. Unintended major surgery was the most frequent (Table 2). When unintended surgery was restricted to true laparoscopic complications (n = 14), rehospitalization became the most frequent complication. Six women had more than one complication, with unintended

Discussion

Our results suggest that interval laparoscopic tubal sterilization generally is a safe procedure with rates of intraoperative or postoperative complications of less than one to two per 100 procedures. There was only one life-threatening event and there were no deaths among 9475 interval laparoscopic tubal sterilizations.

The most frequent complication was unintended surgery, which accounted for more than half of standard complications reported. However, some conversions to laparotomy represent

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Cited by (0)

Supported by an interagency agreement (3-Y02-HD41075-10) with the National Institute of Child Health and Human Development.

1

The U.S. Collaborative Review of Sterilization Working Group: Design, Coordination, and Analysis Center: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. Principal Investigator: Herbert B. Peterson, MD; Project Officer: Joyce M. Hughes; Project Associates: Zhisen Xia, PhD, Lynne S. Wilcox, MD, Lisa Ratliff Tylor; Project Consultant: James Trussell, PhD; Data Collection Centers Project Directors: Norman G. Courey, MD, CM, State University of New York at Buffalo, Erie County Medical Center, Buffalo, New York; Philip D. Darney, MD, MSc, University of California, San Francisco, San Francisco, California; Ernst R. Friedrich, MD, Washington University School of Medicine, St. Louis, Missouri; Ralph W. Hale, MD, Roy T. Nakayama, MD, Kapiolani Medical Center, Honolulu, Hawaii; Jaroslav F. Hulka, MD, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Alfred N. Poindexter, MD, Baylor College of Medicine; George M. Ryan, MD, Edwin M. Thorpe, MD, University of Tennessee School of Medicine, Memphis, Tennessee; Gary K. Stewart, MD (deceased), Planned Parenthood of Sacramento, Sacramento, California; Howard A. Zacur, MD, Lucas Blanco, MD, Johns Hopkins University School of Medicine, Baltimore, Maryland.

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