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    001330

    Two years' experience with minilaparotomy tubal ligation in a freestanding clinic.

    Whitaker KF

    Advances in Planned Parenthood. 1980; 15(3):77-81.

    In 1977 the PPAN (Planned Parenthood Association of Nashville) began providing minilaparotomy sterilization services on an outpatient basis. The experience of 218 women who received sterilizations at the clinic between 1977-1979 indicated that it was feasible and safe to provide this service on an outpatient basis. The historical development of the program, the procedures and instruments used to perform the sterilizations, and the sterilization outcomes for the 218 patients were described. Prior to program initiation, the Medical and Executive Directors of PPAN attended a workshop on outpatient female sterilizations conducted by AVS (Association for Voluntary Sterilization) and the Planned Parenthood Federation of America. Subsequently a protocol for minilaparotomy sterilization was submitted to the National Medical Office of the Federation by the PPAN. The protocol was approved and the program was implemented. Based on the success of the 1st 18 months of operation PPAN received a grant from AVS to train personnel from other clinics to provide similar services. During the 1st clinic visit patients are thoroughly counseled and given a pelvic examination. During the 2nd visit the patient is given a complete physical examination and laboratory tests, including a pregnancy test, are performed. During the 3rd visit the patient receives additional counseling and the sterilization is then performed. A modified Pomeroy procedure is performed under local anesthesia. Patients were discharged 2 hours after surgery. 96% of the patients returned for suture removal and 50% returned for a later recommended check-up. A follow-up survey indicated that more than 90% of the patients were satisfied with the service. For 4 of the 218 patients the sterilization was not completed. In 2 cases the round ligament was mistaken for the tube and sterilization was not achieved, in 1 case the patient became upset and the procedure was halted, and in another case adhesions prevented ligation. At the time of the operation it was discovered that 2 patients had luteal phase pregnancies. There were no major immediate complications but there were 1) 2 cases of subcutaneous hematomas; 2) 1 brief episode of postoperative thrombophlebitis, 3) 2 cases of wound abscesses; and 4) 3 cases of mild cystitis and endometritis.
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