Evaluation of single-stitch tubal ligation in postpartum women.
Permanent contraception by tubal surgery on completion of the family unit is increasingly becoming acceptable to younger women. Contraception by spacing methods during the long span of the reproductive period is impractical because of the cost involved, the fear of failure, and the possibility of side effects. Reversal of tubal surgery may be necessary in some young women as a result of unforseen infant deaths. Old and new techniques of tubal surgery,with or without endoscopy, still require the interruption of a long segment of the tubes (more than 1 cm) except in the spring-clip method, in which only 4 mm of tube is involved. These clips are expensive and not easily available. In a study of 463 women, the clip method was replaced by a single-stitch method to interrupt a small segment (1 mm) of the tubes. However, 24 failures occurred in the 230 women followed for a period of 6-36 months. In view of the high failure rate, use of this method was discontinued. This experience demonstrates that methods causing minimal tubal damage and providing maximum potential reversibility have greater risk of failure.