Use of multiple clips for tubal occlusion in interval laparoscopic sterilization: Circumstances and consequences
Chi, I.C.
Contraception 50(5): 409-416
1994
ISSN/ISBN: 0010-7824 PMID: 7859450 DOI: 10.1016/0010-7824(94)90058-2Document Number: 289790
Occlusion of the fallopian tubes by use of clips has been widely practiced. In some cases the use of multiple clips has been reported, but the reasons for selecting the multi-clip method over the single-clip procedure are not clear. In this retrospective study, data from international records on clip usage was examined for possible answers for selecting single versus multiple clips. Also reported are the complications, complaints, and surgical and post-surgical events. These studies noted that laparoscopic sterilization was performed and that either the Filshie clips or Wolf (Hulka) clips were used in 17 international centers. 79 (3.3%) of 2366 women noted in the records who had the Filshie clip inserted also had multiple clips inserted. With regard to the Wolf clip, 23 (3.7%) of 623 women also had multiple clips inserted. In this study, 102 women occluded by multiple clips were matched with 4 women each (for a total of 408 women) who had a single-clip occlusion procedure. Surgical difficulties in the multiple-clip group were evident. In 72 women (70.6%), surgeons had difficulties in occluding the tubes; in 11 women (10.8%), in grasping the tubes; and in 5 women (4.9%), in finding the tubes. After comparing multiple- and single-clip patients, no significant differences could be identified. Difficulties during the laparoscopic sterilization procedure tended to be the main reason for selection of multiple clips. No increased risk in short-term complications or complaints were reported.