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  • Title: Laparoscopic and minilaparotomy female sterilisation compared in 15 167 cases.
    Author: Mumford SD, Bhiwandiwala PP, Chi IC.
    Journal: Lancet; 1980 Nov 15; 2(8203):1066-70. PubMed ID: 6107689.
    Abstract:
    Three methods of female sterilisation were compared in data from 23 countries: laparoscopy with occlusion by the tubal ring (7053 cases), minilaparotomy with occlusion by the tubal ring (3033 cases), and minilaparotomy with occlusion by the modified Pomeroy technique (5081 cases). The 12-month failure rate was 0.60 per 100 women for laparoscopy/ring and 0.30 per 100 women for minilaparotomy/Pomeroy. The surgical complication rate for laparoscopy/ring (2.04%) was more than twice that for minilaparotomy/Pomeroy (0.79%). The technical failure rate of minilaparotomy/Pomeroy was twice that of laparoscopy/ring, but the complication and method-failure rates were much lower. Failure and complication rates with minilaparotomy/ring were intermediate. For many women seeking sterilisation, a minilaparotomy procedure will be preferable to a laparoscopy procedure. Three of the most commonly used techniques in clinical trials conducted by the International Fertility Research Program (IFRP) in 23 countries--7053 cases of laparoscopy/ring, 3033 cases of minilaparotomy/ring, and 5081 cases of minilaparotomy/Pomeroy--were studied to evaluate their efficiency and safety. Safety and effectiveness were based on the following variables: 1) surgical difficulties; 2) surgical complications; 3) technical failures; and 4) method failures. Overall surgical difficulty, rate of surgical complications, and technical failure rates were standardized for timing of sterilization (eg, interval, postabortion, and postpartum). Life table method was used in determining failure rates. The laparoscopy/ring technique had a 12-month failure rate of 0.60/100 women; minilap/Pomeroy had a failure rate of 0.30/100 women. The laparoscopy/ring technique had a surgical complication rate of 2.04%; minilap/Pomeroy had a corresponding rate of 0.79%. The technical failure rate of the minilap/Pomeroy method was twice that of laparoscopy/ring. Minilap/ring had intermediate failure and complication rates. In developing countries, minilaparotomy procedure is preferred over laparoscopy for women seeking sterilization because of its lower failure rate, safety, efficacy and ease in dealing with complications. The limitation of this study is that the series was not generated by a randomized comparative trial.
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