Female sterilization failure after bipolar electrocoagulation: a 6 year retrospective study

Failed sterilisation: evidence‐based review and medico‐legal ramifications

“…A meta‐analysis has shown no significant difference in failure rate or operative morbidity between mini‐laparotomy and laparoscopy methods of tubal sterilisation 19 . Overall, the failure rates for each method (clip, ring, electrocautery) in recent studies approximate to each other 4,11,12,15,17,20–33 . Significantly, the US CREST showed that bipolar compared with unipolar electrocautery decreased the risk of thermal bowel injury but increased the risk of pregnancy failure and ectopic pregnancy 12,30 …”

“…the round ligament or a fold of peritoneum between the round ligament and tube) 26 . If electrocautery is used, at least 3 cm of the mid to distal portion of the isthmic part of the tube should be coagulated with sparing of at least 2 cm of the proximal tubal stump to reduce failure through cornual fistula formation 1,28 . At least 25 W of unipolar cutting current (rather than coagulating waveform) should be used to achieve complete tubal desiccation 34 ; without transecting the tube through excess electrocautery.…”

“…However, the exact aetiology of tubal lumen regeneration remains unclear. Other factors such as individual's tubal ‘healing’ response, pre‐existing proliferative tubal disease, degree of tubal avascularity and interval from operation are likely to modify tubal lumen regeneration ability 28,40,43–46 . Presently, there is no evidence to suggest that operator fault in sterilisation technique predisposes to tubal lumen regeneration, and therefore this mechanism of sterilisation failure would be considered non‐negligent and independent of operator error.…”

W003 Right Ampullary Ectopic Pregnancy Following Bilateral Tubal Ligation Using Spring Clips

“…7 This reflects the importance of previous sterilization as an aetiologic risk factor for ectopic gestation. 8 …”