Female sterilization monitored by laparoscopy. Evaluation of 2 electrosurgical occlusive techniques

A prospective study with postoperative follow-up at 6 and 12 months was conducted to determine complication rates following sterilization by bipolar coagulation and the results were compared with those of a prospective study of unipolar coagulation. 545 cases of monopolar and 780 of bipolar electrocoagulation performed during 1978 were compared. 83.66% of monopolar and 82.82% of bipolar patients were from urban areas. In the monopolar and bipolar groups respectively 12.47% and 12.05% were illiterate 68.90% and 70.26% had 1-5 years of education and 18.34 and 16.67% had 7 or more years of education. The average age and parity respectively were 32.9 years and 6.05 in the monopolar group and 33.1 years and 6.18 in the bipolar group. 96.15% of procedures were done under general anesthesia with very low rates of anesthetic complications including 2 monopolar and 1 bipolar cases of anaphalactic reactions to the anesthesic inductor and 1 case of cardiac arrhythmia in a bipolar case none of which was serious enough to warrant interruption of the procedure. The overall rate of operative complications was 47.4/1000 including in the monopolar and bipolar groups respectively 8 and 3 cases of uterine perforation 1 and 3 of peritoneal emphysema 1 monopolar case of peritoneal burn 15 and 5 cases of tubal bleeding during the occlusion and 1 monopolar case of bleeding during closing of the wound. The most common immediate postoperative complication was abdominal pain requiring parenteral administration of analgesics experienced by 13.05% of monopolar and 9.23% of bipolar patients. 30.14% of monopolar and 25.00% of bipolar patients had immediate postoperative complications with .73% of monopolar and 1.09% of bipolar patients requiring additional hospitalization. 31.25% of monopolar and 20.78% of bipolar patients had complications during the 1st postoperative week. At the 6 and 12 month follow-up respectively 34.04% and 23.35% of monopolar and 26.25% and 24.61% of bipolar patients reported menstrual alterations although the differences were not statistically significant; 4.25% and 4.37% of monopolar and 3.07 and 8.20% of bipolar patients reported other gynecological problems including pelvic or wound pain late pelvic surgery and pelvic inflammatory disease. No pregnancies were reported in either group. The significantly higher rates of intraoperative tubal bleeding with monopolar coagulation and the risk of electrical burns make it a less desirable method than bipolar coagulation.