Tubal Clips, References and Abstracts, Medical Litigation News

Article References & Abstracts
TUBAL CLIPS

1. Author Garner JP; Toms M; McAdam JG
Institution Department of General Surgery, Ministry of Defence Hospital Unit, Frimley Park Hospital, Camberley, Surrey, UK.
Title Filshie clips retrieved from a femoral hernia.
Source J R Army Med Corps 1998 Jun;144(2): p107-8
ISSN 0035-8665
2. Author Kesby GJ; Korda AR
Institution Division of Obstetrics and Gynaecology, Royal Prince Alfred and King George V Hospitals, Sydney, New South Wales, Australia.
Title Migration of a Filshie clip into the urinary bladder seven years after laparoscopic sterilisation.
Source Br J Obstet Gynaecol 1997 Mar;104(3): p379-82
ISSN 0306-5456
Unique Identifier 95084521
3. Author Scheel-Hincke JD; Berendtsen H
Institution Kirurgisk afdeling, Tonder Sygehus.
Title [Migrating clips--a complication of laparoscopic sterilization with Filshie clips]
Vernacular Title [Migrerende clips--en komplikation til laparoskopisk sterilisation med Filshie-clips.]
Source Ugeskr Laeger 1994 Aug 8;156(32): p4592-3
ISSN 0041-5782
Abstract

The most common method for female sterilization in Denmark is laparoscopic tubal application of Filshie clips. We describe a case of a 35 year old women admitted with a right inguinal abscess. A Filshie clips that had been inserted five years earlier was found by surgical exploration of the abscess. Possible pathogenetic and etiological factors are discussed.
4. Author Klumper F; Peters AA
Institution Academisch Ziekenhuis, afd. Gynaecologie, Leiden.
Title [Migrating clips; a complication following sterilization]
Vernacular Title [Migrerende clips; een complicatie na sterilisatie.]
Source Ned Tijdschr Geneeskd 1991 Feb 9;135(6): p233-5
ISSN 0028-2162
Abstract

Almost twenty thousand laparoscopic sterilizations are performed in the Netherlands yearly. The use of clips (Filshie clips) is increasingly common and has replaced coagulation in many institutes. In spite of the fact that the method is known to provide a permanent form of contraception, women and gynaecologists are uneasy about the method, as a result of the publicity around some pregnancies having occurred after tubal sterilisation and the ensuing liability suits. The laparoscopic findings in two patients with migrating clips are presented. It is indicated how accuracy and documentation of the laparoscopic sterilisation may be increased. This is of utmost importance in view of the legal consequences of failure.
5. Author Stovall TG; Ling FW; O'Kelley KR; Coleman SA
Institution Department of Obstetrics and Gynecology, University of Tennessee, Memphis.
Title Gross and histologic examination of tubal ligation failures in a residency training program.
Source Obstet Gynecol 1990 Sep;76(3 Pt 1): p461-5
ISSN 0029-7844
Abstract

A previous study from this institution revealed laparoscopic tubal sterilization failure rates of 26.5 per 1000 and 45.5 per 1000, respectively, for the tubal ring and spring-loaded clip in procedures performed by residents in training. In an effort to identify potential anatomical reasons for this unacceptably high failure rate, 20 patients becoming pregnant after laparoscopic tubal occlusion underwent bilateral salpingectomy. Gross and histologic evaluation of the surgical specimens demonstrated improper application of the occlusive device in all cases. Seventeen patients were found to have nonoccluded or partially occluded tubes on one or both sides, with all occlusive devices located in the infundibular segment. Two patients were missing tubal rings on one side, and the remaining patient had a tubal ring misapplied to the round ligament. Sixteen residents who had completed a 1-month rotation on the ambulatory surgery service were given a standardized interview to assess their knowledge of proper sterilization techniques as well as their training experience. The frequency of incorrect responses given to four specific questions concerning proper placement of the tubal ring and spring-loaded clip ranged from 43.8-81.2%. The sterilization failure rate at this institution appears to be directly related to the resident surgeon's lack of understanding of the operative technique. Realizing that our institution is not unlike most other resident training programs, we developed a standardized education program including formal instruction of residents in proper sterilization technique and have altered supervisory guidelines for attending surgeons.
6. Author G.Robinson., C. Christie., B. Chambers & G.M. Filshie.
Institution Department of Pathology and Department of Obstetrics and Gynaecology, University of Nottingham Medical School, Queen's Medical Centre, Nottingham, NG7 2UH, England, U.K.
Title Histopathology of the Fallopian Tube Subsequent to Sterilisation with the Filshie Clip, Hulka Clip and Falope Ring.
Source http://www.avalon-medical.com/histopat.htm
7. Author Birdsall MA; Pattison NS; Wilson P
Institution National Women's Hospital, Auckland.
Title Female sterilisation: National Women's Hospital 1988-9 [see comments]
Source N Z Med J 1994 Nov 23;107(990): p473-5
ISSN 0028-8446
Abstract

AIM. To determine the failure rate of all female sterilisation procedures performed at National Women's Hospital in order to identify ways of improving the service. METHODS. A review was made of all sterilisation procedures performed at National Women's Hospital in 1988 and 1989. All patient notes and theatre records were examined. A consumer questionnaire was mailed to all patients monthly for 3 months. If there was no response efforts were made to contact these women via their last known general practitioner. Epsom Day Hospital where 95% of all terminations of pregnancy in Auckland are performed also examined their records. RESULTS. 1094 procedures were performed at National Women's Hospital in Auckland during 1988 and 1989. Failures were classified into two groups: those pregnant at the time of surgical procedure (administrative failures) and those pregnant after the procedure (surgical failure). There were 15 surgical failures (1.4%). Laparoscopy using Filshie clips was the most common method used and had a 1.2% surgical failure rate. Registrars had a 1.3% failure rate, consultants 1.9% and when both a consultant and registrar performed the procedure a failure rate of 0.7% was recorded. Eighty-six percent (6/7) of women who had a subsequent laparotomy after a failed sterilisation were found to have surgical misapplication of the occlusive device. There were 7 (0.6%) women who were pregnant at the time of the procedure. There were no patient or procedure-related factors which were associated with failures. CONCLUSION. Sterilisation is associated with a significant failure rate. Contraception counselling at the time of booking for the procedure needs to be improved. Preoperative pregnancy testing should be introduced to avoid sterilisation procedures in early pregnancy. Surgical misapplication of devices was a common cause of failure, not recanalisation as found elsewhere. From this review it would appear that the involvement of two surgeons lowers the failure rate.