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  • Title: [Laparoscopic tubal sterilisation using Yoon's rings. The technique and psychological effects].
    Author: Dubois M, Houmont M, Haleng-Laret J, Lambotte R.
    Journal: J Gynecol Obstet Biol Reprod (Paris); 1982; 11(5):611-8. PubMed ID: 6217240.
    Abstract:
    So long as certain contra-indications are observed it had been found that the application of Yoon's rings in the isthmial region of the fallopian tube is an efficient way of sterilising women. It is easy and devoid of major operative or post-operative complications. The authors report 245 cases that were treated in a University Hospital Centre. This technique had been particularly well received from the psychological aspect, as has been shown by an enquiry that we conducted between 6 and 48 months after the procedure in patients in this study. 245 tubal sterilizations using Yoon rings were performed at a university hospital center in Liege between July 1977 and June 1980. Average age of patients was 36.3 years, 9.4% were nulliparas and 17.6% were primaparas. In 4 cases an abortion was performed simultaneously. Each patient requesting sterlization was referred to a psychologist or psychiatrist. A multiple choice questionnnaire was sent to each patient in 1981 to assess medium term psychological effects of the sterilization. Fewer than 20% of the sterilizations were performed for medical indications. The average duration of the operation was 35 minutes and the average hospital stay was 3.4 days. Problems with the laparoscope necessitated laparotomy in 3 patients. In 6 cases uterine perforation without hemorrhage occurred. Rupture of the tube occurred in 12 cases, in 1 of which hemorrhage occurred and laparotomy was required. Minor bleeding occurred in 8 cases, incorrect placement of a ring occurred in 3 cases, a ring fell into the abdominal cavity in 6 cases, and a 2nd ring was placed on the same tube in 18 cases. 28.9% of the patients complained of pain in the 1st 24 hours. 1 urinary infection with E. coli, and 2 cases of hemotoma on the abdominal walls occurred post-operatively. 1 pregnancy was recorded after 4922 cycles, giving a failure rate of .4% and a Pearl's index of .24/100 woman years. The failure was due to incorrect placement of the ring. 137 of 209 patients receiving questionnaires responded. 67.4% reported feeling more relaxed and 27.2% reported no change; 43.5% reported better sex life and 48.1% reported no change; 85.6% reported no fear of pregnancy; and 96.4% reported they would repeat the operation. Before the operation, 75.4% of the partners were in favor of it, 2.6% were opposed, and 14.4% had no opinion. At the questionnaire data, 79.3% declared themselves fully satisfied, 5.4% had regrets, and 15.3% had no opinion. The acceptance of this method of contraception on the psychological level appears to be good when adequate pre-operative counseling is provided and the patient is aware of the implications of the procedure.
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