Failure rates are significantly higher following hysteroscopic sterilisation (HS), in a theatre or office setting, compared with laparoscopic sterilisation (LS), a study has found.

A research group from Pittsburgh reviewed the literature and collated a number of studies from which data were extracted and analysed. All studies had to have a minimum of 50 subjects with follow-up for at least 12 months.

No absolute figures were presented, only percentages. Figures for successful sterilisation at the first attempt were: 99%, 86% and 85% for LS, HS in theatre and HS in the office setting at three months and 99%, 88% and 87% respectively six months post-procedure. The respective figures at 12 months were 99%, 95% and 94%.

However, the method by which some patients were eventually successfully sterilised was different from the method they chose initially. Although, some women elected to have a second HS attempt, 7.0% of patients who had had HS in theatre and 5.3% of those who had had HS in an office setting went on to have a laparoscopic procedure. Overall, 5% of patients declined any further sterilisation attempts.

When best and worst case data were compared the difference in success rates at 12 months showed LS to outperform HS by 0.4-10%.

LS is a common and popular form of permanent contraception. HS was introduced as an alternative a decade ago. Hysteroscopic procedures are performed in outpatient or day-care settings and involve placing a pellet into each fallopian tube. The fibrosis reaction evoked causes tubal blockage. Reliance on the method requires confirmation of occlusion by hysterosalpingogram three months after the procedure. Its advantage is that it avoids general anaesthesia and may be carried out in women who are unsuitable for laparoscopy e.g. because of obesity or the presence of abdominal adhesions.

These data suggest that because of its significantly lower success rate HS may be more appropriate for women in whom laparoscopic surgery is contraindicated.

Dr Chris Barclay

• Gariepy AM, Creinin MD, Schwarz EB, Smith KJ. Reliability of laparoscopic compared with hysteroscopic sterilization at 1 year. Obstet Gynecol 2011;118:273-9