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Ring versus clip for tubal sterilization
Title: Two randomized controlled trials comparing the Tubal Ring and Filshie Clip for tubal sterilization
Author: D. Sokal, et al.
Address: Research Triangle Park, NC
Source: Fertility and Sterility 74:525-533 (September) 2000
Summary: The purpose of this study was to compare the effectiveness and safety of the Filshie Clip and Tubal Ring systems when applied via minilaparotomy and laparoscopy. It was a prospective, multicenter randomized controlled clinical trial, with postoperative evaluation by a physician who was masked to the operative technique. Patients were 2746 healthy women. There were 915 in the minilaparotomy study and 1831 in the laparoscopy study, all of whom had requested permanent surgical sterilization. It was discovered during the 12 months after surgery that two women who received the Filshie Clip and two who receive the Tubal Ring became pregnant, giving a 12-month life-table pregnancy probability of 1.7 per 1000 women in both groups. The Tubal Ring was more difficult to apply and had higher rates of tubal or mesosalpingeal injuries at surgery. The women given the Filshie Clip had three cases of spontaneous clip expulsion during the follow-up time. Researchers concluded that both the Filshie Clip and the Tubal Ring are effective and safe for use in tubal occlusion.
Comment: The greatest problems with Falope ring application is the application device cutting through the tube while the ring is being placed and postoperative pain. Both of these should be lessened with the clip. Intuitively it is just scary with the simplicity of clip placement and worry that the tube was completely occluded. Both of these techniques are reported to be better than cautery, which is still widely used due to experience with the procedure.