The women and her partner should be counselled together in a sensitive, non-judgemental manner and all discussions should be documented carefully.
Written information should be provided to the couple as this improves knowledge, leads to less regret and litigation.
A detailed history and examination should be conducted on the couple.
Gynecological history and examinaton will indicate any significant pelvic pathology like fibroids which may influence the decision and need alternative surgery like hysterectomy.
Obstetric history will reveal if any abdominal deliveries were undertaken. It is important to know the age of the partner, the duration and stability of their relationship and if he has fathered any of her four children to reduce the risk of regret.
Medical and surgical history would reveal any anaesthetic and surgical risk factors and influence which partner should go forward with the sterilization.
Enquiry in to their current contraceptive method is important.
History and examination of the partner is important as presence of hernia or hydrocele which may be operated upon at the same time as the vasectomy.
Discussion should involve information about non surgical options of long term reversible contraceptives like Mirena (licenced for 5 year use and failure rate 1.1/100 wome.) , Cu T safe 380 (licensed for 7 years and failure rate of 1.1/100 women) Implants like Implanon (3 years us fiailure rate -<1/100 women They.-have comparable failure rate as tubal ligation.1.8/100 women years.
They should be given the option of vasectomy which can be done under LA and is associated with fewer operation related risks and a lower failure rate than tubal ligation (I in 2000) vs 1 in 200). However, it is not immediately effective and needs the use of contraception until azoospermia is confirmed. They are reassured that it does not increase the risk of testicular or prostate cancer and heart disease. It is however associated in genitor-urinary infections.
A female sterilization involves bilateral occlusion of the tubes performed either via laparoscopy or mini-laparotomy as a day case under GA. At laparoscopy, tubes are ligated using Filshe clips or rings or diathermy. At mini-laparotomy, tubes are ligated surgically or mechanically with clips. The risk of major complications of injury to the bladder, bowel or blood vessel requiring laparotomy should be explained. The failure rate is 1 in 200 with increased risk of ectopic pregnancy and death occurs in 1 in 12000 cases.
Vasectomy and tubectomy are both intended to be permanent procedures; however reversibility is possible.
Failure rates can be minimized by appropriate training of staff and supervision. All equipment should be in good condition. Patients should be properly selected for surgery and the appropriate mode of access to the tubes (mini-laparotomy or laparoscopy) chosen. A senior surgeon should operate on difficult cases. The surgery should be scheduled soon after menses in the follicular phase, if possible. If scheduled in the luteal phase, the surgeon should be confident that she is using effective contraception until the day of surgery. The COC pill should be continued until the end of packet and the IUCD should be removed following next menses. A pregnancy test should be done prior to surgery. Post-partum and post-abortal procedures carry a higher failure rate and tubal occlusion should be done where possible at an appropriate interval after pregnancy. At laparoscopy, Hulka clips and diathermy should be avoided as they are associated with high failure rates. Filshe clip or fallope rings should be used and correctly applied to the mid-isthmic portion ,,1-2 cms away from the cornua, at right angles, encasing the full width of the tubes. This should be explicitly checked by the operating surgeon. Routine use of more than one Filshe clip does not reduce failure rate. At mini-laparotomy, the Madlener or fimbriectomy should be avoided. A modified Pomeroy?s method rather than the Filshe clip should be used at post-partum sterlization as it is associated with a lower failure rate
Posted by Geeta N.
The women and her partner should be counselled together in a sensitive, non-judgemental manner and all discussions should be documented carefully.
Written information should be provided to the couple as this improves knowledge, leads to less regret and litigation.
A detailed history and examination should be conducted on the couple.
Gynecological history and examinaton will indicate any significant pelvic pathology like fibroids which may influence the decision and need alternative surgery like hysterectomy.
Obstetric history will reveal if any abdominal deliveries were undertaken. It is important to know the age of the partner, the duration and stability of their relationship and if he has fathered any of her four children to reduce the risk of regret.
Medical and surgical history would reveal any anaesthetic and surgical risk factors and influence which partner should go forward with the sterilization.
Enquiry in to their current contraceptive method is important.
History and examination of the partner is important as presence of hernia or hydrocele which may be operated upon at the same time as the vasectomy.
Discussion should involve information about non surgical options of long term reversible contraceptives like Mirena (licenced for 5 year use and failure rate 1.1/100 wome.) , Cu T safe 380 (licensed for 7 years and failure rate of 1.1/100 women) Implants like Implanon (3 years us fiailure rate -<1/100 women They.-have comparable failure rate as tubal ligation.1.8/100 women years.
They should be given the option of vasectomy which can be done under LA and is associated with fewer operation related risks and a lower failure rate than tubal ligation (I in 2000) vs 1 in 200). However, it is not immediately effective and needs the use of contraception until azoospermia is confirmed. They are reassured that it does not increase the risk of testicular or prostate cancer and heart disease. It is however associated in genitor-urinary infections.
A female sterilization involves bilateral occlusion of the tubes performed either via laparoscopy or mini-laparotomy as a day case under GA. At laparoscopy, tubes are ligated using Filshe clips or rings or diathermy. At mini-laparotomy, tubes are ligated surgically or mechanically with clips. The risk of major complications of injury to the bladder, bowel or blood vessel requiring laparotomy should be explained. The failure rate is 1 in 200 with increased risk of ectopic pregnancy and death occurs in 1 in 12000 cases.
Vasectomy and tubectomy are both intended to be permanent procedures; however reversibility is possible.
Failure rates can be minimized by appropriate training of staff and supervision. All equipment should be in good condition. Patients should be properly selected for surgery and the appropriate mode of access to the tubes (mini-laparotomy or laparoscopy) chosen. A senior surgeon should operate on difficult cases. The surgery should be scheduled soon after menses in the follicular phase, if possible. If scheduled in the luteal phase, the surgeon should be confident that she is using effective contraception until the day of surgery. The COC pill should be continued until the end of packet and the IUCD should be removed following next menses. A pregnancy test should be done prior to surgery. Post-partum and post-abortal procedures carry a higher failure rate and tubal occlusion should be done where possible at an appropriate interval after pregnancy. At laparoscopy, Hulka clips and diathermy should be avoided as they are associated with high failure rates. Filshe clip or fallope rings should be used and correctly applied to the mid-isthmic portion ,,1-2 cms away from the cornua, at right angles, encasing the full width of the tubes. This should be explicitly checked by the operating surgeon. Routine use of more than one Filshe clip does not reduce failure rate. At mini-laparotomy, the Madlener or fimbriectomy should be avoided. A modified Pomeroy?s method rather than the Filshe clip should be used at post-partum sterlization as it is associated with a lower failure rate
