title: Techniques for the interruption of tubal patency for female sterilisation.
abstract: BACKGROUND
  Female sterilisation is the most popular contraceptive method worldwide. Several techniques are described in the literature, however only few of them are commonly used and properly evaluated.
  
  
  OBJECTIVE
  To compare the different tubal occlusion techniques in terms of major and minor morbidity, failure rates (pregnancies), technical failures and difficulties, and women's and surgeons' views.
  
  
  METHODS
  Originally MEDLINE and The Cochrane Controlled Trials Register were searched. For the 2010 update, searches of Popline, Lilacs, Pubmed and The Cochrane Controlled Trials Register were performed. Reference lists of identified trials were searched.
  
  
  METHODS
  All randomised controlled trials comparing different techniques for tubal sterilisation, regardless of the route of Fallopian tube access or the method of anaesthesia.
  
  
  METHODS
  Trials under consideration were evaluated for methodological quality and appropriateness for inclusion. Nine relevant studies were included and the results were stratified in five groups: tubal ring versus clip, modified Pomeroy versus electrocoagulation, tubal ring versus electrocoagulation, modified Pomeroy versus Filshie clip and Hulka versus Filshie clip. Results are reported as odds ratio for dichotomous outcomes and weighted mean differences for continuous outcomes.
  
  
  RESULTS
  Tubal ring versus clip: Minor morbidity was higher in the ring group (Peto OR 2.15; 95% CI 1.22, 3.78). Technical difficulties were found less frequent in the clip group ( Peto OR 3.87; 95% CI 1.90, 7.89). There was no difference in failure rates between the two groups (Peto OR 0.70; 95% CI 0.28, 1.76). Pomeroy versus electrocoagulation: Women undergoing modified Pomeroy technique had higher major morbidity than those with the electrocoagulation technique (Peto OR 2.87; 95% CI 1.13, 7.25). Postoperative pain was more frequent in the Pomeroy group (Peto OR 3.85; 95% CI 2.91, 5.10). Tubal ring versus electrocoagulation: Post operative pain was more frequently reported in the tubal ring group. No pregnancies were reported. Pomeroy versus Filshie clip: In the only trial comparing the two interventions only one pregnancy was reported in the Pomeroy group after follow-up for 24 months. No differences were found when comparing Hulka versus Filshie clip in the only study that compared these two devices.
  
  
  CONCLUSIONS
  Electrocoagulation was associated with less morbidity including post-operative pain when compared with the modified Pomeroy and tubal ring methods, despite the risk of burns to the small bowel. The small sample size and the relative short period of follow-up in these studies limited the power to show clinical or statistical differences for rare outcomes such as failure rates. Aspects such as training, costs and maintenance of the equipment may be important factors in deciding which method to choose.
authors.affiliation: Effective Care Research Unit, University of the Witwatersrand/University of Fort Hare/East London Hospital Complex, East London, South Africa.
authors.forename: Theresa A
authors.initials: TA
authors.lastname: Lawrie
authors.forename: Juan Manuel
authors.initials: JM
authors.lastname: Nardin
authors.forename: Regina
authors.initials: R
authors.lastname: Kulier
authors.forename: Michel
authors.initials: M
authors.lastname: Boulvain
mesh_terms: D004564:Electrocoagulation / Q000379:methods*; D005260:Female; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D013246:Sterilization, Tubal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D013525:Surgical Instruments