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  • Title: Laparoscopic sterilizations requiring laparotomy.
    Author: Chi IC, Feldblum PJ.
    Journal: Am J Obstet Gynecol; 1982 Mar 15; 142(6 Pt 1):712-3. PubMed ID: 6461254.
    Abstract:
    The risks of particular patient characteristics associated with a change from laparoscopy to laparotomy are delineated and quantified. Data on 23,638 patients who elected to undergo laparoscopic sterilization for contraceptive purposes were reported to the International Fertility Research Program (IFRP) from collaborating international facilities from 1972 through 1978. The tubal occlusion techniques used in the studies included electrocoagulation, the tubal ring, the prototype spring-loaded clip, the Rocket clip and the El Kady method. A total of 59 patients required laparotomy for completion of the sterilization procedure, representing an overall incidence of 2.5/1000 procedures, which is comparable to rates from the U.S. 10 cases were excluded from the matched analysis, as the laparotomies were attributable to instrument problems. Of the remaining 49 cases, 41 were individually matched with a patient in whom the sterilization was completed via the intended occlusion technique and approach (control subjects) according to the following provider variables: center; type of study; operator; and tubal occlusion technique (all identical). More case subjects than control subjects had a concurrent induced abortion, and more case subjects were obese (interval sterilization patients only). 2 patient characteristics were significantly different between the 2 groups: more case subjects than control subjects reported previous abdominal operations and more case subjects had abnormal pelvic conditions at examination before the operation or during laparoscopy. When these 2 characteristics were considered simultaneously, women with both had the highest estimated relative risk of laparotomy, women with only a history of abdominal surgery were intermediate in risk, and those with only an abnormal pelvic examination had the lowest risk, all in reference to the case and control subjects with neither characteristic. The majority of the pelvic conditions were detected during laparoscopy, so only a history of abdominal operation can be used as a predictor.
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