INCIDENTAL FINDINGS DURING LAPAROSCOPIC TUBAL STERILIZATION IN CAMPS-OUR EXPERIENCE OVER THE PAST 30 YEARS.
Journal Title: IJAR-Indian Journal of Applied Research - Year 2017, Vol 7, Issue 1
Abstract
INTRODUCTION: Laparoscopic tubal sterilization is one of the leading methods of contraception used all around the world. More than 190 million couples worldwide use surgical sterilization as a safe and reliable method of permanent birth control. Over the past 30 years we have operated on more than 1 lac women across the states of Karnataka, Kerala, Maharashtra and Tamil Nadu. Apart from carrying out tubal sterilization we have come across several incidental findings such as collection in the pouch of Douglas (POD) suggestive of pelvic inflammatory disease(PID) , missed copper T’s and unruptured cornual and tubal pregnancies. MATERIALS AND METHODS: A retrospective trial was carried out over a span of 30 years between 1985 to 2015 when tubal sterilization was carried out by the Ron-Manvi method in the South Indian states of Karnataka, Kerala, Maharashtra and Tamil Nadu in camps. During this procedure several incidental missed copper T’s and unruptured cornual and tubal pregnancies were documented. The missing copper T’s were retrieved either by laparoscopy or laparotomy in the same setting or in a second setting. Those patients with an unruptured cornual or tubal pregnancy underwent a laparotomy for the termination of pregnancy either in the same setting if facilities were available or immediately after shifting the patient to the nearest possible tertiary care centre . If a collection was noted in the pouch of Douglas, it was suctioned off and post operatively the patient was started off on medical management of pelvic inflammatory disease. RESULTS: Over the past 30 years more than 1 lac women have undergone tubal sterilization by Ron-Manvi technique across various states of South India. During our study period it was noticed that on laparoscopy collection was found in the POD suggestive of a PID in about 584 women . Copper T’s which the patient had failed to get it removed after the stipulated time period were found in about 4 cases . Unruptured cornual pregnancy was found in about 6 cases and unruptured tubal pregnancy was found in about 12 cases. CONCLUSION: Incidental findings during during any laparoscopic surgery are to be expected and the surgeon should be well equipped with a sound knowledge of anatomy and also possess the skills required to deal with any such findings during surgery. Thus laparoscopic method of tubal sterilization is not only serving the primary motive of birth control but also behaving as a diagnostic and therapeutic tool for the management of conditions which would have otherwise gone unnoticed until the patient developed complication secondary to those conditions.
Authors and Affiliations
Dr Satish Kumar Kagwad, Dr Shashikala C K, Dr Suraj Kagwad
Keywords
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