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Tubal sterilization can be performed laparoscopically or hysteroscopically — but is one approach superior to the other? In a retrospective cohort study, investigators used a commercial insurance database to assess the outcomes of laparoscopic and hysteroscopic sterilization (42,391 and 27,724 women, respectively; mean age, 37).
At 2 years of follow-up, cumulative risks for pregnancy were 2.4% and 2.0% for hysteroscopic and laparoscopic sterilization, respectively (adjusted hazard ratio (aHR), 1.20). Hysteroscopic sterilization was more likely to be associated with menstrual dysfunction (27% vs. 22%; aHR, 1.23) and less likely to be associated with pelvic pain (21% vs. 26%; aHR, 0.83) than laparoscopic sterilization. At 5 years, fewer women who had hysteroscopic sterilization underwent subsequent hysterectomy (11% vs. 14%; aHR, 0.65).
Perkins RB et al. Gynecologic outcomes after hysteroscopic and laparoscopic sterilization procedures. Obstet Gynecol 2016 Sep 5; [e-pub]. (http://dx.doi.org/10.1097/AOG.0000000000001615)
Comment
In this large series, both hysteroscopic and laparoscopic sterilization were associated with higher pregnancy rates (2.4% and 2.0%) than have been reported elsewhere for the levonorgestrel IUD (0.06%; Contraception 2015; 91:280) and subdermal implant (0.05%; Drugs 2011; 71:969). Moreover, both surgical sterilization techniques were associated with relatively high rates of menstrual dysfunction, pelvic pain, and subsequent hysterectomy. Given these findings along with the high cost of surgical sterilization, IUDs may represent a better approach to long-term contraception for many women.