Fallopian Tube Sterilization

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Fallopian Tube Sterilization

Numerous Fallopian tube sterilization techniques are available to provide obstruction to the Fallopian tubes to prevent sperm and oocyte from fertilizing and being carried into the uterus. Obviously, with so many techniques available no one technique has satisfied all the criteria to come as close as possible to 100% effectiveness and be associated with a simple outpatient technique.

No technique has been 100% successful. In general, most techniques have had a failure rate of 4 pregnancies/1000 patients operated on. Generally, failures have occurred with two techniques: recanalization of the Fallopian tube and development of a tuboperitoneal fistula. Most failures occur within the first 2 years of surgery, although they have been reported as late as 10 years following surgery. Successful tubal reanastomosis to allow pregnancy has been directly proportional to the amount of tube destroyed. Those sterilization operations that destroy the most Fallopian tube have the least successful pregnancy rate after reanastomosis, and those techniques that have the least tubal destruction have the best pregnancy rates after reanastomosis.

Physiologic Change. There is little physiologic change to the patient following tubal obstruction. There has been no evidence that there is a change in sex steroid production by the ovary.

Points of Caution. All sterilization procedures have reported morbidity to the gastrointestinal tract and the urinary tract from entering the abdominal cavity. Very little difference can be demonstrated by one technique versus another technique.

Hemorrhage from the Fallopian tube secondary to the sterilization procedure does occur.

Technique

The Pomeroy technique introduced in 1930, involves taking a section of Fallopian tube, tying the base of the tube with a synthetic absorbable suture, and excising a knuckle of tube for pathologic confirmation that a tubal sterilization operation has been performed. It is a traditional and effective method of female sterilization. Its failure rate is in the range of 4/1000, and most failures probably occur through recanalization of the tube.

The Kroner operation, introduced in 1935, removes the fimbriae from the Fallopian tube. The stump of the ampullar portion of the Fallopian tube is tied, and the fimbriae are removed.

Hulka clip sterilization, introduced in 1972, involves the placing of a locking Silastic metallic clip across the Fallopian tube. This technique is least destructible of the Fallopian tube and gives the best results for reanastomosis if the patient changes her mind. It is an ideal technique in very young women desiring female sterilization, should they have a change in their marital status and/or change in their attitude toward further fertility.

In 1970, the technique of laparoscopic electrocoagulation was popularized. Various modifications to the technique have been made, e.g, bipolar, unipolar, but there have been few differences in results. The salient feature of this technique is that it provides thorough coagulation of the tube so that a section of evulsed tube will not have bleeding from the proximal or distal end of the remaining tube nor the bed of the mesosalpinx.

The Falope ring, introduced by In-Bae Yoon, M.D. in 1974, is a simple, inexpensive technique in which a Silastic band is placed around a knuckle of Fallopian tube. The knuckle is not excised as in the Pomeroy technique. The Silastic band stays in place and creates the obstruction.