Esterilización tubaria transvaginal: experiencia de 4 años en el hospital universitario de caracas

Evaluar la experiencia con la tecnica de esterilizacion tubaria via vaginal en el Hospital Universitario de Caracas y el Ambulatorio del IVSS Patrocinio Penuela Ruiz, entre enero 2014 y noviembre 2017. Metodos: Investigacion descriptiva prospectiva y transversal en 412 mujeres no puerperas, en edad fertil que solicitaron esterilizacion quirurgica. Se practico colpotomia posterior para localizar las trompas y realizar la esterilizacion. Resultados: La edad promedio fue 33,2 ± 5 anos; 41,5 % tenian de 1 o 2 partos, 23,3 % 1 o 2 cesareas previas y0,7 % 3 o 4 cesareas. El tiempo quirurgico promedio fue 18,2 ± 9,4 minutos y la perdida sanguinea 21,3 ± 31,1 cm3, sin necesidad de hemoderivados. Se observaron adherencias en 0,7 % de los casos con conversion a laparotomia en 2. Hubo un tercer caso de conversion a via abdominal por sangrado moderado que no se logro resolver via vaginal. Las adherencias prolongaron el tiempo quirurgico y se relacionaron con la necesidad de conversion a laparotomia. No hubo complicaciones posoperatorias. Segun la escala visual analoga, 92,2 % de las pacientes tenian dolor entre 3 y 5 a las seis horas y a las 12 horas habia disminuido en 97,8 % a 0-2. La tasa de embarazo posterior al procedimiento fue de 0,7 %. Conclusiones: La esterilizacion quirurgica tubarica transvaginal es posible en la mayoria de las pacientes, aun con cesareas anteriores, se caracteriza por corto tiempo quirurgico, sangrado escaso, dolor leve, ausencia de cicatrices visibles, rapida recuperacion y pocas complicaciones. To evaluate the experience with tubal ligation by colpotomy incision in patients who assisted to the Gynecology Unit of University Hospital of Caracas and Patrocino Penuela Ruiz Hospital form January 2014 to November 2017. Methods: Prospective and transversal descriptive research in 412 non-puerperal women, aged, fertile who requested surgical sterilization. Posterior colpotomy was performed to locate the tubes and perform sterilization. Results: The average age was 33.2 ± 5 years; 41.5% had 1 or 2 deliveries, 23.3% had 1 or 2 previous caesarean sections and 0.7% had 3 or 4 caesarean sections. The average surgical time was 18.2 ± 9.4 minutes and the blood loss 21.3 ± 31.1 cm3, without the need for blood products. Adhesions were observed in 0.7% of cases with conversion to laparotomy in 2. There was a third case of conversion to the abdominal route due to moderate bleeding that could not be resolved vaginally. The adhesions prolonged the surgical time and were related to the need for conversion to laparotomy. There were no postoperative complications. According to the analogous visual scale, 92.2% of the patients had pain between 3 and 5 at 6 hours and at 12 hours had decreased by 97.8% at 0-2. The pregnancy rate after the procedure was 0.7% Conclusions: Transvaginal tubal surgical sterilization is possible in most patients, even with previous caesarean sections; it is characterized by short surgical time, scarce bleeding, mild pain, absence of visible scars, rapid recovery and few complications.