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Query: UMLS:C0028754 (obesity)
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Litigation in the UK resulting from sterilization failures is on the increase, with claims averaging 40,000/case. This suggests that physicians must be extremely careful with preoperative counseling and the conduct of the sterilization procedure. Failed sterilization litigation may allege negligence, trespass to the person, or breach of contract. It is important be patients be informed that there is a risk of failure, especially when sterilization is performed at the end of a cesarean section procedure or induced abortion. Patients should be asked to sign the specially designed consent form, and the record should state that the implications of the procedure and its risks were explained. Another way failures can be minimized is through improvements in surgical technique. If there are problems with laparoscopic visualization, a laparotomy should be performed and patients with obesity or pelvic adhesions should be warned of this possibility in advance. Laparoscopic sterilization should be performed only by those with thorough training in the method, and junior staff should be carefully supervised. Given the fact that the world "sterilization" implies permanence, which can't be guaranteed, it is suggested that the procedure be referred to by what is actually done--e.g., tubal ligation and excision or laparoscopic application of clips to the fallopian tubes.
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PMID:Failed sterilization and the law. 334

Sexual sterilization is the major form of fertility control in women who are more than 30 years old. Clinicians usually use laparoscopy to perform female sterilization. They may occlude the fallopian tubes with a clip or ring or coagulate the tubes using bipolar diathermy. It is usually performed on an outpatient basis. Nonsteroidal anti-inflammatory drugs can generally control the postoperative pain. A serious immediate but rare complication is death, which is often associated with the anesthesia. Complications related to the experience of the surgeon include damage to bowel or blood vessels and tearing of mesosalpinx. Obesity or pelvic adhesions often necessitates either laparotomy or abandonment of sterilization. Some long term complications are hysterectomy and menstrual disorders. Presterilization counseling needs to examine the possibility of regret and to discuss failure rates and complications. Reasons for regret are young at time of sterilization, psychosexual disorder, change of partner, change in financial circumstances, sterilization performed at time of crisis, and death of a child. The failure rate for the Filshie clip is 0.1%. Reasons for failure include pregnant at the time of the procedure, clips placed across the round or ovarian ligament, incomplete occlusion, and fistula formation and recanalization. Failure rates are higher when the sterilization is done during pregnancy because the tubes are thicker and more vascular. Vasectomy involves severing and ligating the vas deferens in both scrotums. Immediate complications are hematoma and infection. Vasectomy patients need to bring 2 semen samples for sperm counts 3-4 months after the procedure. Azoospermia signals a successful vasectomy. If sperm are still present 5-6 months after the procedure, the surgeon should conduct exploratory surgery under general anesthesia. Long term side effects include testicular discomfort and perhaps prostate cancer. The evidence is unclear about the link between vasectomy and prostate cancer, however.
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PMID:Male and female sterilisation. 807 40

After our first LAVH in September of 1990, we performed a prospective clinical trial. All women referred for abdominal hysterectomy were given the option of LAVH. A total of 253 patients met the strict criteria prohibiting vaginal hysterectomy. Those criteria utilized included obesity, uterus> 12-14 week size, pelvic pathology, prior pelvic surgery, pelvic adhesions, and lack of pelvic relaxation. All patients were consented for LAVH with potential complications including infection, anesthesia accidents, and hemorrhage listed on the release of liability. Also included in the release of liability was the potential for laparotomy. A combination of techniques were used, and procedures were performed mainly at a tertiary hospital center by attending and resident physicians. Surgery in 248 (98%) patients was completed via LAVH. Mean operating room time was 135 minutes (65-140 min range). Mean hospital stay was 1.2 days (1-5 day range). Mean recovery time was 2.5 weeks (2-6 week range). Mean EBL was 350 ml (100-1250 ml range).
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PMID:Laparoscopic-Assisted Vaginal Hysterectomy (LAVH) 9/90 - 9/93: Data from 253 Cases 907 76

With mounting evidence of the beneficial effects of the retained cervix, supracervical hysterectomy is gaining popularity worldwide. In this series of 123 patients, obesity and pelvic adhesions were the chief factors that prevented amputation of the cervix at the time of hysterectomy. We propose that these are cogent indications for planned supracervical abdominal hysterectomy in order to minimize damage to the adjacent viscera. This option is best justified by a risk/benefit analysis.
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PMID:Supracervical hysterectomy in Trinidad. 1183 53

270 women underwent laparoscopic tubal sterilizations with Yoon silicone rings at the Obstetrics and Gynecology clinic of the Dakar teaching hospital in Senegal between 1979-84. Written consent of the husband was required for all married women. 235 women underwent sterilization because of grand multiparity and 34 for medical reasons. The medical indications included 1 case of cardiopathy, 12 of severe psychosis, and 3 of serious vasculorenal syndrome. 70 operations were done under local and 200 under general anesthesia. 1 patient was 20 years old and the rest were 33-44. The average age was 32 and the average parity was 8. Observations during the laparoscopies included 40 cases of pelvic adhesions, 10 of uterine retroversion, 30 of congestive tubes, and 13 of ovarian cysts. Placement of the rings was usually accomplished easily 2-3 cm from the cornu. In 6 cases, rings were lost in the peritoneal cavity and in 14 cases a tube was ruptured. In 1 case the extent of a patient's obesity was underestimated and an IUD was inserted instead of a ring. 1 case of allergy to pethidine and 1 case of subcutaneous emphysema were observed. 174 follow-up hysterosalpingographies were done. 1 pregnancy occurred 4 months after the sterilization operation. Postpartum hysterosalpingography revealed a broken ring. The period of hospitalization varied from 48-72 hours and averaged 60 hours.
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PMID:[Tubal sterilization using the Yoon silicone ring: 270 cases at the Obstetric Gynecological Clinic of DANTEC Teaching Hospital, Senegal]. 1231 25