There is currently a huge variety of contraceptive methods to choose from, all have the same aim – the prevention of pregnancy. The objective of this article is aimed at dispelling some of the myths associated with laparoscopic ‘versus’ hysteroscopic sterilisation. The method which is most suitable for an individual will depend on a number of factors such as age, sexual lifestyle, current relationship, family status and medical history.
The Filshie Clip is considered the most effective and simple means of female laparoscopic sterilisation. With over 27 years of clinical use, a proven success rate of 99.76% and in the region of 10 million Filshie Clips having been successfully applied worldwide, the Filshie Clip’s strong clinical pedigree is recognised by leading surgeons around the world as the ‘number one’ choice for female surgical contraception / sterilisation. With an extremely low failure rate of 0.24%, the Filshie Clip System also has the lowest incidence of ectopic pregnancy: 4% of the 0.24%, in other words 0.001% of failures result in an ectopic pregnancy.
Filshie Clip tubal ligation is usually performed by laparoscopic surgery. The procedure is carried out by either single or dual incision laparoscopy, or via a laparotomy incision following caesarean section delivery. Once the surgeon has identified the Fallopian tube the Filshie Clip is applied to the Isthmic portion by fully encapsulating the tube causing complete occlusion. This is then repeated for the second Fallopian tube. The procedure is usually performed using general anaesthesia and patients may go home a few hours after an outpatient procedure, it can also be performed successfully under local anaesthesia.
No woman should consider any method of sterilisation unless she is certain that she does not wish to become pregnant in the future. However, relationship circumstances can and do change and it is a real possibility that a sterilised woman may want a reversal of the procedure in the future in order to conceive. Although the Filshie Clip procedure should be considered as a permanent form of surgical contraception / sterilisation, another of its key benefits is that the Filshie Clip destroys less than 4mm of the Fallopian tube, therefore, the procedure can be reversed following re-anastomosis of the Fallopian tubes, with over a 90% success rate. Hysteroscopic sterilisation, on the other hand, must be regarded as totally permanent, as reversibility is not possible.
The Filshie Clip is extremely effective for larger tubes (postpartum) and is used extensively in the USA for postpartum sterilisation. There is no contraindication to the application of the Filshie Clip immediately following childbirth; conversely this is contraindicated for hysteroscopic methods of sterilisation. Unusual uterine shape or pathology does not affect the application of the Filshie Clip for surgical sterilisation. However, hysteroscopic sterilisation is contraindicated where uterine pathology or an unusual shaped uterus are present.
In essence, outside of the very small risk associated with anaesthesia, there are very few complications associated with the Filshie Clip.
However whilst hysteroscopic sterilisation is recommended in an outpatient setting, it is not without complication, some of these being noted below:-
- Failure to place both micro-inserts during the first procedure can happen on occasion and the surgical technique is not as simple as tubal ligation.
- Tubes not becoming blocked at 3 months after placement can occasionally occur.
- One or both micro-inserts do not always stay in the body (expulsion).
- There is a risk of one or both micro-inserts poking through wall of the tube or uterus (perforation).
- It is recommended to have a Hysterosalpingogram (HSG) at 3 months to confirm that the tubes are fully occluded. During this period the patient must rely on an alternative method of contraception.
- If the HSG shows a non-occluded fallopian tube the patient cannot rely on this hysteroscopic device for contraception and may require further surgery.
Whereas, using the Filshie Clip, no HSG is required following successful placement of the Clips on the Fallopian tubes. Although no alternate form of birth control is required, contraceptive precautions should continue to be taken until after the patient’s next period following sterilisation. The reason being, depending on what stage the patient is in their menstrual cycle when the sterilisation procedure takes place, ovulation may have already passed beyond the site where the Filshie Clips are placed on the Fallopian tubes. Once the patient has had a period following sterilisation, the contraceptive method can then be discontinued.
Another key clinical advantage of the Filshie Clip is that in-vitro fertilisation (IVF) is NOT contraindicated following the application of Filshie Clips. However, with hysteroscopic sterilisation, it is not well known whether the device affects the success of IVF, and if the patient were to fall pregnant following such a procedure whether the micro-inserts would harm the patient’s health or the health of the foetus.
Consideration should also be given to pre-menopausal women with heavy menstrual bleeding that may be considering endometrial ablation. Given that the Filshie Clip occludes the Fallopian tubes from the outside rather than blocks the tubes from the inside, the Filshie Clip System is compatible with ALL endometrial ablation techniques and can be used in conjunction with any such procedure.
In summary…Filshie is a globally recognised product that is… Beautifully Simple and Simply Beautiful !!
For more information please contact Femcare-Nikomed Ltd; a global medical device company, supplying products to the Gynaecology, Urology and General Surgery markets with direct operations in the UK and Australia. Elsewhere Femcare-Nikomed market their products through a distribution network covering some 45 countries. With over 27 years of experience in the pursuit of clinical excellence, the
Femcare-Nikomed name has become synonymous with a wide product portfolio of quality and innovative products.
For further information visit the Femcare-Nikomed web site: www.femcare-nikomed.co.uk
Stuart Court, Spursholt Place, Salisbury Road, Romsey, Hampshire SO51 6DJ, UK