| Popis: |
Different methods of sterilization were evaluated. Laparoscopic techniques were the most satisfactory because they had lower pelvic and incision infection rates and shorter hospitalization and convalescent times than laparotomy lower pelvic infection rates than culdoscopy and culpotomy. Via laparoscopy, sterilization by coagulation and cutting, spring-loaded clips and bands was an effective, safe method. Mechanical problems with the applicator and optics and decreased visibility resulted in more technical failures and difficulties and more misapplication with the clip applicator. Although the total complication rates were similar with all methods, bleeding from the tubes and wound and pelvic infections were more frequent with silastic-band technique. Long-term complications, such as dysmenorrhea and menometrorrhagia and especially those resulting in hysterectomy after laparoscopy, are infrequent. Pregnancy rates are low after laparoscopic sterilization with coagulation and silastic bands as compared to the clip. Rates of complications with sterilization combined with abortion or delivery are only slightly higher than after abortion without sterilization and much less than the combined complications that would be anticipated from abortion and interval sterilization. To make colpotomy, culdoscopy and minilaparotomy easier and potentially safer, mechanical techniques using the spring-loaded clip and silastic band are being evaluated. Simplified techniques that can be administered via the cervix, such as Quinacrine, may be practical in the future.Data from 401 culdoscopy, 799 colpotomy, 482 laparoscopy, and 279 laparotomy sterilizations reported on standardized IFRP forms were analyzed in an effort to evaluate contemporary female sterilization methods. "Technical-failure" rates of the 4 approaches were acceptable and were not significantly different. Rates of "technical difficulties," particularly difficulties in visualizing the tubes, were significantly higher for endoscopic techniques as compared to the open techniques. Rates of "operative complications" were significantly higher with culdoscopy as compared to colpotomy, laparoscopy, or laporotomy. Rates with the latter 3 procedures were low and not significantly different. Early postoperative complications (those occurring between the time the patient left the operating room and the time of the 1-8-week followup visit) were signficantly lower for laporoscopy patients. Culdoscopy patients had higher rates than other patients. With vaginal techniques, pelvic infection was the most frequent complication. With abdominal techniques, superficial wound separation and infection accounted for 50% of the laparotomy and 73% of the laparoscopy early postoperative complications. Postoperative convalescence was less with endoscopic techniques. In sum, it appears that in service programs where culdoscopy, colpotomy, laparoscopy, and laparotomy are used in healthy women, the following is valid: all approaches were associated with satisfcatory technical failure rates and morbidity; laparoscopy was usually preferable to culdoscopy, colpotomy, or laparotomy; and although laparoscopy may be the preferable method, individual surgeons may be able to perform sterilization by colpotomy, culdoscopy, and laparotomy with lower morbidity than they can by laparoscopy. Review of the advantages and disadvantages of different laparoscopic techniques led to the following conclusions: all methods were practical, with satisfactory morbidity, technical failure, and difficulty rates; "technical failure" and "technical difficulty" rates were higher with the spring-loaded clip method; the total operative complication rate was low with all methods; and suspected pelvic and wound infections were more frequent after sterilization by the silastic-band techniques for undetermined reason. Long-term complications, such as dysmenorrhea and menometrorrhagaia and especially those resulting in hysterectomy after laparoscopy were infrequent. Pregnancy rates were low after laparoscopic sterilization with coagulation and silastic bands as compared to the clip. The significantly higher rates with the spring-loaded clip as compared to cautery and cutting and the silastic band have been attributed to misapplication of the clip to the tube and to defects in the clip. Laparoscopic sterilization after abortion and in the puerperium appears safe based on the data of the operative and early postoperative complication rates in 833 patients who were sterilized in the interval. Mechanical techniques using the spring-loaded clip and silastic band are being evaluated in the effort to make colpotomy, culdoscopy, and minilaparotomy easier and potentially safer. |
