Laparoscopic sterilization. A comparison of current techniques.
Current techniques of laparoscopic sterilization--bipolar electrocoagulation, endocoagulation, silicone ring, Hulka clip and Filshie clip--were analyzed from a large pool of international data. Technical difficulties have been encountered much less with electrocoagulation than with the silicone ring, Hulka clip or Filshie clip. There have been fewer technical failures with bipolar electrocoagulation and endocoagulation than with the ring or clip. Surgical complications have been the fewest with bipolar electrocoagulation and endocoagulation but have been more serious (electrical burns). The Hulka and Filshie clips have had lower complication rates than has the silicone ring. The greater technical difficulties and failures and greater surgical complications with clips and rings have been due to technical problems in applying them in cases of tuboperitoneal pathology. The pregnancy rates from method failure have been acceptably low with all the methods. Ectopic pregnancies are a serious problem with bipolar electrocoagulation and endocoagulation. The pregnancy rates after reversal surgery have been highest with the Hulka and Filshie clip. Electrical methods seem to be preferable in women with pelvic adhesions and tubal pathology. Clips seem to be preferable in women who may be candidates for future sterilization reversal.