[Bilateral tubal occlusion] Oclusion tubaria bilateral.
Bilateral tubal occlusion is a permanent method of family planning indicated only for couples who have achieved their desired family size or women for whom pregnancy would constitute a grave medical threat, regardless of age or parity. Candiates for this procedure should be fully informed about it. Absolute contraindications include pregnancy, pelvic infection and similar pathological states which entail heightened surgical risk. Relative contraindications such as obesity, pelvic tumors, endometriosis, and previous abdominal surgery signify increased technical difficulty and require surgical skill, while other relative contraindications are resolved through appropriate choice of surgical method. The abdominal route is currently preferred to the vaginal route because of its greater simplicity and freedom from complications. Abdominal sterilizations can be performed postpartum, postabortum, after cesareans, or as an interval procedure. The most often utilized among available methods of tubal occlusion are the Pomeroy technique, application of silastic bands, tantalum clips, or electrocoagulation. The method of occlusion and site of the incision depend on the timing of the procedure. The Pomeroy technique of ligation and resection is still the most widely used in family planning programs because of its simplicity and effectiveness. There are 2 traditional modes of laparoscopic sterilization, 1 using unipolar or bipolar electrocoagulation or thermocoagulation and 1 using silastic bands or metal or plastic clips to occlude the tubes. Electrocoagulation gives satisfactory results but has a relatively high rate of complications due to unplanned tissue damage, hemorrhage, or injury to surrounding organs. Thermocoagulation at low temperature permits laparoscopic sterilization with minimal tissue damage, but the number of cases is still too small for adequate evaluation. Silastic bands placed on the ampular portion of the tube destroy about 3 cm of tube by aseptic necrosis. It is easy to perform, offers good possibilities for several, has a low complication rate, and requires no hospitalization. Hulke and Filshie clips also give good results. Laparoscopic methods entail low rates of morbidity attributable to the procedure, with many of the complications caused by anesthesia. Tubal occlusion by the vaginal route or by colpotomy or culdoscopy is done only in association with planned vaginal surgery because of high complication rates. Research is nevertheless underway on endoscopic procedures such as electrocoagulation of the tubal ostium, application of sclerosing agents, or insertion of tubal plugs. The number of women worldwide undergoing voluntary surgical sterilization increased from 20 to 110 million between 1970-82 and is expected to reach over 400 million by 2000.