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JOURNAL OF THE TENNESSEE MEDICAL ASSOCIATION. 1986 Feb; 79(2):75-6.275 laparoscopic tubal ligations were done safely and economically at the Planned Parenthood of Memphis outpatient clinic from May 1983 to June 1985. Patients were carefully selected and counselled, eliminating those with previous abdominal surgery, excluding cesarean section, and those with ongoing pregnancy or serious gynecological or medical problems. The trained staff of experienced laparoscopic surgeons and certified registered nurse anesthetists practiced emergency procedures before surgery. Anesthesia was a minimal amount of nalbuphine (Nubain) 20 to 40 mg and droperidol (Inapsine) 1.25 to 2.5 mg; or fentanyl 0.1 to 0.25 mg and droperidol 1.25 to 2.5 mg; occasionally nitrous oxide inhalation. Some women received droperidol 1.25 to 2.5 mg or diazepam 2.5 to 5 mg beforehand. The laporoscopic procedure, performed through a small intraumbilical incision, employed the fallop ring. The incision was closed with 000 Dexon subcuticular sutures. There were minor side effects in 23: nausea in 20, vomiting in 2 and wound infection in 1. Two pregnancies occurred: 1 was not detected in the preliminary pregnancy test and the other was a procedure failure. The sterilization program is considered safe and resonably priced, $450 compared to $1150 to 1469 in area hospitals outpatient clinics.
Lancet. 1984 Jul 21; 2(8395):144-5.The objective of the World Health Organization (WHO) project, an international, prospective study conducted by centers in England, India, Columbia, Nigeria, and the Philippines, was to investigate the effects of tubal occlusion on the mental and physical health and psychosexual and menstrual functioning of women choosing to undergo the procedure for contraceptive purposes only. A subsequent report presents details and results of the English component of the study. 2 groups of healthy multiparous women having either interval sterilization (at least 6 months since an obstetric event) or postpartum sterilization (within 72 hours of delivery) were recruited. For each group, a control group was recruited from women using or planning to use nonpermanent contraceptive methods. All women were interviewed preoperatively and again 6 weeks and 6 months after the operation by standardized techniques. The results showed that sterilized women did not differ from the control samples in mental state, as assessed by the Present State Examination or in subjectively assessed mental or physical health or abdominal pain. More sterilization subjects than control subjects reported improvement in sexual satisfaction at the later follow-up. Many of the subjects reporting adverse effects at follow-up had revealed disturbances at the initial asssessment. All these women had at least 2 living children. They were women living in stable marriages or other relationships that had lasted an average of over 9 years. They were free from physical or mental ill health before sterilzation. They had their sterilizations voluntarily and solely for the purpose of keeping their families small. It comes as no surprise that, relative to a general population sample, the mental state of sterilized women in the study actually seemed to improve. A need exists for methodoloically sound studies that would identify social and psychological conditions under which sterilization might have ill effects.