LAPAROSCOPIC STERILIZATION FAILURE......

LAPAROSCOPE INSTRUMENT VARIOUS PARTS

            Laparoscopic sterilization was once thought to be safe, simple procedure with advantage of minimal hospital stay and potential for further success of Tubal recanalization of late people are loosing confidence in it due to its failure rate. Thus there is a declining curve for Laparoscopic sterilization. In addition, a laparo ligation failure acts as a wet blanket for those planning to undergo sterilization procedure. To evaluate various causes responsible for laparoscopic sterilization failure, the present study was undertaken.

           A total of 175 patients of failed laparoscopic sterilization, who came from different places with varying duration of Gestation, were studied. Patients who had become pregnant after previous laparoscopic sterilization were included in the study.

      Depending on patients willingness and medical fitness , termination of pregnancy along with Sterilization by modifies Pomeroy’s method was done. Simultaneously the ring applied during previous laparoscopic sterilization was traced and data analyzed.

               It was observed that patients were so concerned about the failure of this operation that most came for consultation soon after the missed period. Only33% presented during second trimester of pregnancy. Out of 175 subjects, 6 were against termination or any type of sterilization procedures and continued the unwanted pregnancy. Therefore exact cause of failure could not be ascertained in them. Amongst remaining cases , a few were fit for termination and underwent abdominal sterilization.

             Nobody in the failure group was willing for a  laparoscopic sterilization again. In the present study failure rate could not be assessed as the denominator was not known. Various cases irrespective of number are having , rings applied partially on fallopian tube , ring was applied on one fallopian tube and other ring could not be traced. In many cases ring was applied on Round Ligament and in remaining it was  on mesosalpinx.

               On further analysis , the rings were applied on both round ligament and then mesosalpinx and in minority of cases rings were found broken and were hanging loosely along with mesosalpinx and fallopian tube.

VARIOUS METHODS OF TUBAL LIGATION

            To sum up in all cases rings application was faulty, hence leading to increase rate of litigation. Mechanical devises usually fails , when they are not properly applied has also been observed in number of studies. Slippage or milking effect on fallope ring can occur if the ring is placed on fatty tube or on oedematous tube. Quality of ring always remains in mind of surgeon , Government supplies of rings are there, hence what ever the ring is there surgeon has to apply. Adherence to strict criteria will minimize the failure rate due to breakage of rings

               It can be concluded that a proper identification of anatomical structure is necessary before applying the ring. The ring should be of good quality and should not be applied on oedematous or fatty tube to reduce the failure rate.