Evaluation of laparoscopic sterilisations in rural camps.

This study reports on laparoscopic sterilization camps in rural India conducted in the state of Gujarat by the Baroda Medical College and in the state of Maharashtra by KEM Bombay. Researchers followed up acceptors at 3 months and 1 year after ligation. The variables used to evaluate the safety and efficacy of the camp approach were 1)site and organization of the camp 2) surgical difficulties and complications and 3) method failures. The Baroda team organized 240 small camps during 1981-82 at an average distance for acceptors of 15 kms. The Bombay team organized only 5 large camps at an average distance of 35 kms. The Baroda team consisted of a gynecologist trained in laparoscopy assisted by a trainee and no anesthetist. The Bombay team consisted of 4-6 operators 2-4 assistants and an anesthetist. All Bombay operators had at least 3 years of experience compared to the Baroda team in which surgeons with at least 3 years of experience performed only 81.2%of the procedures. The Baroda team performed 7103 ligations and the Bombay team performed 2073. The average ages of women who underwent ligation were 31.9 and 28.9 and average parity was 4.0 and 3.5 for Bombay and Baroda respectively. 35.9% of the Baroda teams women and 79.4% of the Bombay teams women resumed normal activities within 4 days. The Baroda camps had a follow-up rate of 99.3% at 3 months while the Bombay teams follow-up rate at 3 months was 78.4%. The 2 most common reasons for seeking medical advice following the operation for both groups of women were pregnancy and stitch abscess. The Baroda team reported 8 method failures during the 1-year period following the operation; the Bombay team reported no method failures. The authors recommend that the camp approach continue with the following suggestions: 1) only trained experienced laparoscopists should perform operations 2) camps should be organized at the District Hospital level or at an upgraded Primary Health Centre or transportation facilities should be available to shift women to a hospital if necessary 3) potential acceptors must have a check up before the operation 4) a surgeon should no perform more than 30 operations per day 5) the team should include a trained anesthetist and 6) the local paramedical personnel should have major responsibility for organizing the camps.