ABSTRACT
PIP: Experience with 1000 minilaparotomy sterilizations performed over 6 years in a community hospital in Melrose, Massachusetts are reported. The method used was the Tural (tubouterine resection and ligation) technique. The Tural procedure was developed as a modification of previous surgical techniques. A loop of fallopian tube is grasped with a Babcock clamp and doubly tied with a double 0 chromic catgut. The tied loop is then excised and both free ends are doubly tied separately with double 0 surgilon suture. At the end of the procedure both severed ends of the tubes diverge from each other. In the 1000 case studies, 578 were primary interval sterilizations and 145 were sterilizations performed at the time of cesarean sections. The primary interval patients were done via a minilaparotomy Pfannenstiel incision, and the postpartum patients via a semicircular periumbilical incision. In 1980, the average postpartum hospital stay was 3.4 days. The average postpartum hospital stay with tubal sterilization added was 3.7 days. There was never a need to stop in midprocedure with minilaparotomy or extend the operation because of poor visibility. There was no unusual bleeding, cancelling of the procedure because of adhesions, adherent retroversion, or other pelvic disease. There were no pregnancies, no complications, and no hospital readmissions. Minilaparotomy for tubal sterilization emerged as a safe, economical alternative to conventional laparoscopy. It offers greater operative simplicity and avoids the rare major complications of visceral, vascular, and thermal injuries associated with laparoscopy. Because of disastrous consequences in a small but significant number of cases with laparoscopic electrocautery of the fallopian tubes, a method of nonelectric laparoscopic sterilization was sought by several investigators. A comparative study of female sterilization conducted by the International Research Program revealed the tubal ring was associated with a higher failure rate than electrocoagulation, the Racket clip, or modified Pomeroy technique. An unrecognized bowel injury is 1 of the most serious complications in laparoscopic sterilization. Uchida reported no failures and minimal complications in more than 20,000 minilaparotomies over a 28-year period. The argument that there is more postoperative pain with a minilaparotomy than a laparoscopic procedure was not found in this experience. Some of the positive aspects of minilaparotomy for sterilization are: no shoulder pain secondary to peritoneal insufflation; no contraindication for conditions such as obesity and previous surgery; and thermal injuries to bowel and pelvic organs are prevented.^ieng
