Tubal ligation (sterilization) by a modified Madlener method.
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From October 1977 to April 1980, 51 women were sterilized. Transabdominal access was most frequent, while the sterilization itself was mostly performed according to the Madlener method. Postoperative complications occurred in 3 women. In all of them the sterilization was performed by colpotomy posterior according to the Madlener method. In two women it was combined with additional gynaecological intervention. This confirms the already known fact that there are much more complications if sterilization is performed transvaginal by or combined with other operative interventions. After the performed sterilization the majority of women did not notice any changes in their menstrual cycles or in their general state of health. It is also positive that more than a half of women were more satisfied with their sexual life after than before sterilization.
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Restoration of tubal patency after surgical sterilization in which the luminal continutiy is interrupted requires either uterine implantation of the patent distal segment or resection and end-to-end anastomosis of patent adjacent segments. Although it is logical to assume that after most tubal ligations the intramural segment remains normal and end-to-end anastomosis is possible, both segments should be evaluated and tested prior to the plastic reconstruction. The results of 178 operations collected from the literature and the author's 23 attempts at surgical reversal of previous tubal operations for surgical sterilization were described. The over-all pregnancy rate after resection and end-to-end anastomosis was 39.0%; after uterotubal implantation, it was 19.4%. The latter procedure was performed in 60% of the patients. The small series of reports makes it difficult to evaluate conception rates or to judge the merits of specific reconstructive operative techniques.
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During the period of 1970--1979 there were 303 patients sterilized by the Madlener method. Out of the them number. The highest number was delivered by caesarean section (182, 60%), and the highest number of the sterilized in the group of caesarean, section were multiparae with seven and more living children (102, 89.5%), then those with the third caesarean section (38, 76%), the fourth (3, 75%), the second (22, 10%), and the first caesarean section (17, 3.42%). Special conditions for sterilization were age, more than 30 years old, with three and more children with medical and socio-economic indications. In 21 women (40%) sterilization was performed as an additional intervention to the other laparatomies, when there was a special care about the number of living children (above three), age and medical indications. There were 3 (0,99%) failed sterilisations (one ectopic pregnancy and two in utero). The authors advocate women's free declaration for sterilization and respective legal acts.
The authors present their 13 cases of sterilization in which a spontaneous recanalization of tubes occurred. Out of these 13 cases, 11 underwent sterilization after the operative Madlener method, while in the remaining 2 cases a laparoscopic method by thermocoagulation was applied. Recanalization in most cases (7) developed 15 or more months after operative sterilization. An adequate passage of tubes was verified in 12 cases through pregnancy, while only in one case HSG was applied, showing a spontaneous recanalization of the right tube.
Advances in female sterilization have been made over the last five years in both its techniques and medico-social acceptance. Prior to 1970, the majority of tubal sterilizations were carried out by partial or complete surgical excision of both tubes by laparotomy in most cases, or by partial salpingectomy by an anterior or posterior colpotomy in selected cases. The traditional operations by the abdominal route comprised the Madlener method, the Pomeroy method, the Irving method and the Aldridge method. These methods will not be discussed further.
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The authors used a scanning electron microscope to study epithelial damage to the rabbit fallopian tube after sterilization with different methods and its subsequent capacity to regenerate after recanalization. Thirty female NZW rabbits were divided into five groups and sterilized using the following methods: 1) Madlener 2) Pommeroy, 3) clips, 4) unipolar coagulation, 5) bipolar coagulation. Each group was divided into subgroups of two and submitted at differing intervals to a second laparotomy, during which one tube was removed and the other anastomosed according to Winston's method. Four weeks after the second laparotomy all the rabbits were sacrificed, the remaining tube removed, and all tubes examined with the scanning electron microscope. The results indicate that mechanical methods of occlusion such as clips offer greater recovery possibilities than those in which the lesion is extended to the mesosalpinx. There further exists a correlation between the time that elapses after sterilization and regeneration of the epithelium.