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Laparoscopic Pomeroy tubal ligation as a teaching model for residents.

We reviewed our preliminary experience with laparoscopically directed bilateral midtubal resection for tubal ligation (endoscopic Pomeroy) as a potential teaching tool for the acquisition of endoscopic skills during residency training. Thirty-five laparoscopic Pomeroy and 206 banding procedures were reviewed. Age, parity and weight were similar in the two groups. The operative time for banding was reduced slightly after experience with > 10 procedures. In contrast, the operative time for laparoscopic Pomeroy procedures decreased dramatically after individual experience with only a few (< or = 5) procedures. The mean operative time for the Pomeroy group approached that of the more traditional banding technique at five procedures. Our data indicate that laparoscopic Pomeroy sterilization can be an effective teaching tool for operative laparoscopy, allowing residents to repeatedly perform an easy and safe procedure that incorporates basic techniques. Advanced operative endoscopic procedures could then be taught more efficiently after the acquisition of basic skills.

Adult

Twice-failed tubal ligation: a case report.

The case is presented of a twice-failed tubal ligation in a woman with six previous children. The first failure followed laparoscopic tubal occlusion by silastic falope rings, while the second failure was subsequent to tubal ligation and division via minilaparotomy. No similar reports have been reported in the East African Literature. Possible reasons for failure are discussed.

Adult

Ectopic pregnancy following tubal sterilization surgery.

In a consecutive study of 100 women with the surgical diagnosis of ectopic pregnancy confirmed by histologic examination, 7 women were found to have had prior tubal sterilization surgery. In 3 of these cases the sterilization procedure was bilateral tubal fulguration. The diagnosis of ectopic pregnancy must be given careful consideration if patients conceive after a tubal sterilization procedure of any type.

Adult

Surgical sterilization at the time of cesarean delivery.

The cesarean section operation has been recognized for more than a century as an ideal time for the obstetrician to effect sterilization, usually with minimal morbidity, by way of one of the methods of tubal ligation. The physician must choose between simple, quick methods such as the Pomeroy or Parkland, with their slightly higher but acceptable failure rates, or the more elaborate and foolproof methods that involve burial of the tubal ends, such as the Irving or Uchida, which are technically more difficult and time consuming. The authors stress that whichever procedure is utilized, the surgeon must resist the desire to elaborate on proven techniques; otherwise, higher than published failure rates may result. It is important for the patient to understand the risks, both of immediate morbidity and remote failure, and to give her informed consent. Attentive presterilization counseling may identify the patient who will regret the loss of her fertility.

Cesarean Section

Microsurgical tubal anastomosis in the rabbit following three types of sterilisation procedure.

The reversibility of Falope ring, Pomeroy and unipolar cautery methods of sterilisation was examined in 30 rabbits. Using microsurgical techniques, an overall pregnancy rate of 56.6% was attained. Reversibility was more readily achieved and resulted in a higher pregnancy rate after Falope ring than Pomeroy or cautery sterilisation. The pregnancy rate after each method of sterilisation seems to correlate with the results obtained for reversal of sterilisation in the human.

Animals

Female sterilization by the vaginal route: a positive reassessment and comparison of 4 tubal occlusion methods.

Over the last 15 years female sterilization by the vaginal route has been abandoned in favour of the abdominal approach via a laparoscope or a suprapubic incision. This was justified when the vaginal route was used for a fimbriectomy or a Pomeroy type of sterilization. The use of tubal occlusion methods designed for the laparoscope has simplified the technique of vaginal sterilization and lowered the morbidity. Four hundred and ninety consecutive cases over an 18-year period are reviewed. Four hundred and eighty five were completed vaginally. The methods used were Pomeroy with catgut, Falope ring, Hulka and Filshie clips. The Filshie clip was the most satisfactory. Vaginal sterilization is suitable for day care. The readmission rate was 1%. There was no case of pelvic infection in 177 clip cases but 5 in 173 where the Pomeroy technique was used. The pregnancy rate was highest with the Hulka clip. The overall rate was 1%. With clip methods strong analgesics were only required in 6% postoperatively and only 14% took any analgesic after returning home; consequently return to normal activities was rapid. The patient's weight was not related to operative difficulty when clips were used so the vaginal route may prove to be the method of choice in the obese. Filshie clip sterilization via the posterior fornix of the vagina could be the most cost-effective method of sterilization available at present. The vaginal route needs reappraisal using contemporary methods of tubal occlusion.

Adult

Pomeroy tubal ligation by laparoscopy and minilaparotomy.

Pomeroy tubal ligation is a widely-used method for surgical female sterilization. A laparoscopic technique of Pomeroy tubal ligation using endoloop sutures is compared with the conventional technique of Pomeroy tubal ligation by minilaparotomy. Forty-four women requiring sterilization were randomly selected for either laparoscopy (n = 24) or minilaparotomy (n = 20). Mean operative time in the laparoscopy group (18.90 +/- 5.56 with a range of 12-35 minutes) was not significantly different from that in the minilaparotomy (23.12 +/- 8.24 with a range of 15-45 minutes) group. In all women, tubal specimens confirmed tubal histology. Both laparoscopy and minilaparotomy procedures may be performed for Pomeroy tubal ligation with minor morbidity. In clinics with appropriate conditions, Pomeroy tubal ligation by laparoscopy may be preferable to minilaparotomy.

Adult

[Clinical experience with modified method of tubal ligation].

OBJECTIVE: To evaluate the clinical results with modified tubal ligation method. METHODS: From 1983 to 1992, 700 cases of modified tubal ligation operation with tubes cut and overlapped were performed in our hospital, and this was compared with 602 cases of Pomeroy's and 502 cases of modified Uchida's method. Patients were followed at 6 months, 2 and 5 years. Pregnancy rates, menstruation disturbances, lower abdominal or back pain, and leucorrhea were observed. RESULTS: Patients with modified tubal ligation method had a pregnancy rate of 0.43%, which was significantly lower than that of Pomeroy's 1.50% (P < 0.05). The modified method group also had few complications. The occurence rate of menorrhage and prolonged bleeding were apparently lower than that of Pomeroy's too (P < 0.01). CONCLUSION: This modified tubal ligation method is more effective and practicable than Pomeroy's and modified Uchida's method.

Adult

Changes in menstrual blood loss after four methods of female tubal sterilization.

One-hundred females requesting tubal sterilization were included in this study. They were enrolled into 4 groups, each n = 25. They were allocated to a particular method of sterilization on a randomized basis. The four modalities used were: laparoscopic Falope ring application, bipolar electrocoagulation, Hulka clip application and Pomeroy tubal ligation via minilaparotomy. The menstrual blood loss (MBL) was quantitatively estimated, using the alkaline hematin method, prior to sterilization and after 3, 6 and 12 months. No significant changes in MBL were observed after the four sterilization techniques. Moreover, they did not differ significantly in this context.

Adult