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After 12 years, how effective is the Pomeroy tubal sterilization technique? #656/6
I had a tubal ligation 12 years ago when I was 25 years old. I had the Pomeroy technique done. How effective is this technique and can the tubes rejoined after long period of time (12years)?




You are using an extremely effective contraceptive ? tubal sterilization via the Pomeroy technique (tubal excision).  Here are several paragraphs about the technique of the occluding fallopian tubes:

Occluding the fallopian tubes

There are three types of occlusion procedures ligation and excision, use of mechanical devices (such as clips or rings), and electro coagulation (the burning of the fallopian tubes).

Ligation and excision methods

Ligation involves tying each fallopian tube with suture material and cutting it.  Ligation and excision techniques also include removing a section of the tube.  These methods, also called partial salpingectomy, are used with minilaparotomy (interval or postpartum), laparotomy, and colpotomy.  They cannot be used during laparoscopy without highly specialized techniques and equipment.

The most commonly used methods are the Pomeroy and Parkland techniques.  The Pomeroy technique entails identifying and fallopian tube, tying of a 2-cm loop of the tube's midportion, and cutting away the tube above the tie.  Absorbable suture is used for this procedure, so the stumps of the tube will separate when the suture reabsorbs [Peterson, Pollack, & Warshaw, 1997b].  In the Parkland method, the tube is tied in two places and the piece in between is cut away, leading to the immediate separation of the tubal stumps [Peterson et al, 1997b].

There techniques are highly effective, have low complication rates, are inexpensive, and do not require a specialist surgeon.  They are preferred over the Uchida and Irving techniques (which are technically difficult and take longer to perform) and over fimbriectomy, or the Kroener technique (which has a higher rate of complications and failure) [Metz, 1978].

            What are the failure rates of the various forms of tubal sterilizations after 10 years of use?

The failure rate after 10 years of using tubal sterilization as your contraceptive varies depending on:
· The procedure performed
· The experience of the surgeon
· The fertility of the woman. Failure rates are higher in women having tubal sterilization in the mid 20s, for example, than for women having the same procedure done in their 30s

The ten-year cumulative failure rates for tubal sterilization are outlined below by type of procedure performed. [Peterson ? 1996]

Unipolar coagulation: 0.75%
Postpartum tubal excision: 0.75%
Silastic (Falope or Yoon) ring: 1.77%
Interval tubal excision: 2.01%
Bipolar coagulation: 2.48%
Hulka-Clemens clip: 3.65%

Failure rates after one year of use of the more recent Filshie clip are approximately 1 pregnancy per 1000 women. Long-term cumulative failure rates for this technique are not yet available. [Fiddes TM ? 1996]

 

            The above failure rate would be lowered still further among men with a low sperm count.

 

Tubal sterilization using the ESSURE technique is definitely the most effective form of tubal sterilization, leading some clinicians to switch to this approach for a high percentage of all sterilization for women.

            Essure Sterilization Safe, Effective at 5 Years

San Francisco:  Hysteroscopic sterilization with Essure microinserts appears safe and effective for at least 5 years after the procedure, according to a poster presented by John F Kerin, M.D, at the annual meeting of the American College of Obstetricians and Gynecologists.

            Dr. Kerin of Flinders Medical Centre, Adelaide, Australia, and colleagues from the Selective Tubal Occlusion Procedure 2000 Investigators Group followed 643 women for up to 5 years after they underwent the procedure.  All women had received bilateral placements of Ensure microinserts as part of phase II or phase lll clinical trials sponsored by Conceptus Inc., the device's manufacturer.

            Not a single pregnancy occurred in 29,357 women - months of follow-up, Dr. Kerin reported.  The age-adjusted cumulative bayesian effectiveness rate at 5 years was 99.74%. [Robert Finn ? 2005]        

Comments on Essure vs. Laparoscopic sterilization by Dr. Mitch Creinin:

Essure is less invasive, safer, and more effective than laparoscopic sterilization.  It makes no sense why any physician would not embrace a less invasive technique for sterilization (except when insurance coverage for the newer procedure is lacking).  Although the company must report failure rates according to FDA guidelines, common sense can be used to truly understand the efficacy.

            If 100 women walk into the OR to get Essure, 98% will leave having the procedure completed.  At 3 months follow-up, about 1% of women will either have the coils missing or the tubes will be open (based on our experience at the University of Pittsburgh).  About 99% of women whose tubes are open will have blocked tubes within 3 more months.  But, for the sake of making a simple argument, let's just assume that the entire1% needs to use another method.  Thus, 97% of women will be successfully able to rely of Essure.  I would argue that the chance of pregnancy for these women is zero.  Their tubes are blocked due to scarring; we don't tell women with infertility due to tubal scarring that if they wait long enough, the tubes will unscar.  Once they are scarred, they are done!  Thus, I would argue that 97% of women will be 100% assured they can never get pregnant.  The other 3% will need to use another method like laparoscopic sterilization or an IUD.  The pregnancy rate for these women will be about 1 per 100 over the next 5 years.

            Thus, with laparoscopic sterilization, 100% of women have a 1 per 100 risk of getting pregnant in the next 5 years.  With Essure, only 3% of women have a 1 per 100 Risk; the rest have a zero risk.  Voila?Essure is more effective and less invasive.  Moreover, with Essure, 95% of women are back to normal activities within 24 hours whereas with laparoscopic sterilization, 50% of women are back to normal activities in about 4 days. [Dr. Mitch Creinin -2006]

      

          The questions from our website also provide additional information about tubal sterilizations:
Robert A. Hatcher MD, MPH
Emeritus Professor of Gynecology and Obstetrics
Emory University School of Medicine
Atlanta, GA
---2008-01-11


Managing Contraception for Your Pocket 2013-2014
  


Managing Contraception for Your Pocket 2013-2014
  

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