| Abstract: | The reasons for failure in a series of 544 laparoscopic sterilizations by Hulka-Clemens clips are analyzed. Patients were divided into 2 groups: 1) 327 women sterilized by clips, and 2) 217 women sterilized with clips simultaneous to suction abortion. Most patients were 31-41 years of age. 10 pregnancies were observed in the 4-12 month follow-up, most of which occurred 2-4 months after clip application. None of the pregnancies were ectopic. The higher failure rate in group 2 (7%) compared to group 1 (1.83%) is due to the larger uterine size in the pregnant women. Most failures were attributable to a lack of technical training on the part of operators. In most cases, the clips were applied to a structure other than the tube: round ligament (3 cases), fimbriae (2 cases), utero-ovarian ligament (1 case), twisted spring (3 cases). The cause for failure remains unknown in 1 case. Compared with other sterilization methods (e.g., diathermic coagulation, Yoon ring), the Hulka-Clemens clip procedure has a low rate of method failure. Other studies have noted the following reasons for failure: material, application in already pregnant patients, incomplete nipping of the tubal lumen, application on another structure, and decrease of pressure on the jaws of the clip. Subsequent pregnancies with this method can be avoided by attention to optimal presentation of the uterus during the procedure to facilitate tubal cupping, and adequate supervision when the procedure is done by an inexperienced operator. |
