sterilization

Sterilizationperminant contraception

Female sterilization
This involves the mechanical blockage of both fallopian tubes to prevent sperm reaching & fertilizing the oocyte.
Bilateral salpingectomy or hysterectomy may be used if there is coexistent gynaecological pathology.

It is most commonly performed by laparascopy under general anesthesia as a day case.

Alternative technique is mini-laparatomy with small suprapubic incision or through the posterior vaginal fornix[colpotomy].
Avariety of methods used for tubal occlusion
Include:
Ligation
Electrocautery
Laser
Falope ring
clips

Female Sterilization Overview

Anatomy

Ampulla

Isthmus
Fimbria
Infundibulum

• Procedure

• Timing
• Technique
• Minilaparotomy
• Post Partum
• Post Abortion
• Interval
• Mechanical Devices (Clips, Rings)
• Tubal Ligation or Excision
• Laparoscopy
• Interval Only
• Electrocoagulation (Unipolar, Bipolar)
• Mechanical Devices (Clips, Rings)
• Laparotomy
• In conjunction with other surgery (Cesarean section, salpingectomy, ovarian cystectomy, etc.)
• Mechanical Devices (Clips, Rings)
• Tubal Ligation or Excision
Methods of female sterilization


Informed concent
• Discussion with patient must take place and cover the following details:
• It must be a voluntary decision
• Discussion of other options
• Discussion of method of sterilization
• Sterilization is permanent
• Probability of failure
• Discussion about methods of contraception for prevention of STDs
• Special consideration for women with mental disabilities

Monopolar coagulation

• It is laparascopic procedure

• Complications
• Bowel Burn
• Bleeding
• Longer portion of tube is damaged
• Failures and ectopic pregnancy

Bipolar coagulation

• Laparoscopic
• Benefits
• Most common method of laparoscopic sterilization
• Burn several locations along the tube
• Complications
• High rate of ectopic pregnancy
• Potential for bowel burns
• Reversals are potentially more difficult due to the extent of tube damage

Destruction of the Entire Fallopian Tube: “Three Burn” Technique

Falope ring

• Mechanical occlusion invented in 1974
• Tubal occlusion accomplished by placing a silicone band around the tube
• Thicker tubes may be problematic
• May not be suited for postpartum
• Complications
• Increased patient discomfort during recovery – large area of necrosis
Failure Rate: 17.7/10001 (1.8%)

Falope Ring/Yoon Band

Filshie Tubal Ligation System
Can be used in minilaparatomy & laparascopy
Used as interval or postpartum srerilization

Methods of Female Sterilization

Pomeroy technique

• Incision – suprapubic and subumbilical
• Isthmic portion is ligated twice
• Segment is then excised
Benefits
• Easy technique
• Highly effective
• Relatively inexpensive)
Tied


Cut
Final result

Parkland technique

• Isthmic portion of tube is segmented and ligated at two points
• An avascular area in the mesosalpinx is opened
• Proximal and distal ligated and segment exiced
• Benefits
• Good success rates
• Few complications
• Inexpensive to perform

Irving technique

• Bury the proximal tubal stump within the myometrium
• Benefits
• Used in conjunction with cesarean delivery
• Complications
• Moderate level of difficulty to perform
• Pomeroy and Parkland are quicker
Failure rate: 1/10001


Hysteroscopic procedure
Essure
Essure microinsert sterilization device

•

complications

-Short term
Anesthetic problems.
Intra-abdominal organ damage.
Gas embolism.
Thromboembolic disease.
Wound infection

Long term-

• Women may experience regret post-procedure
• Ectopic pregnancy
• Failure rate 1-2/1000 operation.
• Menstrual disorders
• Psychological disorders


Reversibility
All surgical tubal occlusion procedures are considered to be permanent female sterilization methods
success restoration of tubes does not mean always success of pregnancy and carries a significant risk of ectopic pregnancy

Male sterilization(vasectomy)

-Safe and permanent birth control procedure
- Involve division or occlusion of the vas deference on each side to prevent the passage of sperm & seminal fluid from epididymis

Its advatages are-safe, inexpensive,done under local anesthesia& with less complications than
female sterilization.i
Its disadvantages is not effective immediately,
Need 12- 16 weeks to be effective.
The man should have semin analysis till two samples free from sperms.

Vasectomy procedure

Office visit – approximately 1 hour
Local anesthetic to the overlying skin
Clamp the vas through the skin
Incision made
Small segment removed (3 mm)
Cut segments
-Tied
-Cauterized
-Clipped


complications
-Bleeding ,hematoma :
-Infection
-Sperm granuloma at the cut ends of the vas
-antisperm Antibodies development
-Chronic pain:
-Failure as 1 in 1000
-Concerns of testicular and prostate cancer but
Data do not support a risk

reversal

50-70% who had procedure reversed are fertile
Better success the shorter the interval from procedure to reversal
<3 yrs – 76% successful
>15 yrs – 30% successful