title: Hysteroscopic tubal occlusion: sterilization after failed laparoscopic or abdominal approaches.
abstract: BACKGROUND
  When tubal ligations cannot be performed because of dense postoperative adhesions, options for female sterilization are very limited. As the incidence of cesarean delivery rises and the occurrence of peritubal adhesions increases, tubal ligation using abdominal or laparoscopic surgery may become increasingly technically difficult. Hysteroscopic tubal occlusion provides a method of permanent sterilization when an abdominal or laparoscopic approach is unsuccessful.
  
  
  METHODS
  Three patients with failed tubal ligations by abdominal or laparoscopic approaches were referred to our institution. Their cases were complicated by technically difficult surgeries with dense intraabdominal adhesions. Hysteroscopic tubal occlusion was successfully performed in each patient.
  
  
  CONCLUSIONS
  Hysteroscopic tubal occlusion can be used for permanent sterilization when abdominal or laparoscopic approaches are not possible.
authors.affiliation: Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA. rustycalpelmd@yahoo.com
authors.forename: Michael L
authors.initials: ML
authors.lastname: Podolsky
authors.forename: Nita A
authors.initials: NA
authors.lastname: Desai
authors.forename: Thaddeus P
authors.initials: TP
authors.lastname: Waters
authors.forename: Paul
authors.initials: P
authors.lastname: Nyirjesy
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D010535:Laparoscopy; D012086:Reoperation; D013246:Sterilization, Tubal / Q000379:methods*