Sterilization

· Uncategorized
 Sterilization means a surgical procedure to block or remove a part of female or male genital tract to prevent the fertilization.

Female sterilization

It can be performed during C-section, postpartum, post abortion or as an interval procedure.

Methods

Minilap techniques–

It can be interval , post abortal or postpartal.

Pomeroy‘s method :

It is the most common method.Loop of fallopian tube is elevated and ligated with chromic catgut. Mid portion is cut after crushing it or without crushing depending upon the choice of surgeon.
After several weeks two ends of the tube will get separated.
Modified pomeroy’s method :
After performing pomeroy’s some surgeon’s apply a non absorbable suture on the medial side of the ligation done.It is for the better efficacy and less failure rate.Some surgeons do the procedure with vicryl or non absorbable material.The procedure is modified by many surgeons according to their choice and availability of the suture material at the time of operation.
Pomeroy’s tied
Pomeroy’s cut
End result of Pomeroy’s [2]

Irving’s method :

After cutting the tube in mid portion , it’s proximal end is buried in the uterus and distal end in broad ligament.This procedure is usually not performed now a days.

Uchida’s :

Distal end is ligated and proximal is buried in the broad ligament.It is also less commonly performed now a days.

Laparoscopic ligation :

Can be done with bipolar cautery or falope rings or clips like fishie clip and hulka clips.
In laparoscopy camps and at tertiary centres falope ring is used most commonly and in bigger hospitals with more facilities bipolar is used.
Clips and rings destroy less oviductal tissue than the cautery.Chances of misapplication of ring or clip can be more in case of adhesions and thickened tube.
Clip[3]
Falope ring
Laparoscopic ligation with bipolar
Filshie clip

Interval minilap :

Incision is given 2-3cms above the pubic symphysis, midline or transverse, depending upon the choice of surgeon.With the help of finger and retractor, tube is elevated by identifing it’s fimbrial end.It’s mid portion is grasped with babcock forcep and ligation is performed as explained above.
Post partum sterilization–Either performed during C- section or after normal delivery.Fundus is very high up just after delivery. 2-3cms subumbilical incision is given after normal delivery and ligation is performed. It is a better choice and patient gets motivated easily if you tell her it’s simplicity.She can rest better during the puerperial period.

Complications :

  • Haemorrhage
  • Infection
  • Anesthetic complications
  • Injury to the adjacent structue

Reversal

Requires microsurgical re-anastomosis.Pregnancy rates are low with reversal following electrocoagulation method.It is higher with clips and rings and surgical methods.
Resultant pregnancy is more likely to be an ectopic pregnancy.

Failure rate

  • Pomeroy’s —4 per 1000
  • Irving—nil
  • Uchida’s—nil

Laparoscopic

  • Bipolar—4 per 1000
  • Falope ring—4 per 1000
  • Filshie clip—1 per 1000
  • Hulka clip—2 per thousand.
failure varies , depending upon the skill of surgeon and the choice of the method..In camps ligation is performed in hurry, sometimes they miss an early pregnancy usually in lactating woman and she comes with second trimester pregnancy later on.It is not the failure of procedure but continuation of the previously existing early gestation.

Male sterilization

Vasectomy

It involves the permanent surgical interruption of the vas deferens.It can be performed as an out patient procedure under local anesthesia.The procedure hardly takes 15 minutes.
Now a days NSV ( non scalpel vasectomy ) is performed.So there is no need to get afraid.
It is not immediately effective.Spermatozoa mature in vas for around 70 days prior to ejaculation.So 3 months  are needed to deplete the vas.Post vasectomy semen analysis is required to determine the effectiveness of the procedure and other methods are to be used till then.

Complications

  • Wound haematoma
  • Infection
  • Sperm granulomas

Reversal

It is difficult.It has only 50% success rate.
Vasectomy is safer , mortality is zero.
It is less expensive also.
In India especially in villages, it is a myth that they will become impotent after the operation and it is usually the female partner who has to undergo an IUCD insertion or sterilization.

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