Page 24 - World Journal of Laparoscopic Surgery

ORIGINAL ARTICLE
Is Previous Abdominal or Pelvic Surgery a Risk Factor in

Laparoscopic Sterilization? A Retrospective Case Study

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Shirish Shivling Dulewad , Varsha Narayana Bhat , Prachi Vasanth Koli 3
AbstrAct
Objective: The present study is to evaluate the risk involved, difficulties encountered, as well as the safeness of laparoscopic sterilization in
cases of previous pelvic or abdominal surgery.
Design: A retrospective study was carried out between January 2017 and January 2019 at Dr Shankarrao Chavan Government Medical College
and Hospital, Nanded, Maharashtra.
Setting: Tertiary Care Hospital, Nanded, Maharashtra.
Materials and method: Laparoscopic tubal ligation (LTL) was performed using Falope ring in all the cases.
Results: Mean age of the study population was 26.67 years, and mean parity being 3. The most common previous pelvic or abdominal surgery was
cesarean section 96% followed by open appendicectomy 3%. About 14% of them had pregnancy termination (less than 12 weeks of gestation)
with LTL and 86% of them had undergone interval LTL. Omental adhesions up to the anterior abdominal wall and in the pelvis were seen in
19.5% of cases, and adhesiolysis was required in 3.5% of them to complete the procedure. Minimal peritubal adhesions were noted in 3% of
them, and ligation was successfully completed in all by adhesiolysis. No major intraoperative or postoperative complications were documented.
Conclusion: Laparoscopic sterilization is associated with low morbidity and hence it is safe in women with previous pelvic or abdominal surgery.
Keywords: Laparoscopic sterilization, Medical termination of pregnancy, Pelvic or abdominal surgeries.
World Journal of Laparoscopic Surgery (2022): 10.5005/jp-journals-10033-1525

IntroductIon 1–3 Department of Obstetrics and Gynecology, Dr Shankarrao Chavan
Laparoscopic tubal sterilization can be considered as a safe, Government Medical College and Hospital, Nanded, Maharashtra,
authentic, and preferable method of sterilization. It can be performed India
at any time other than immediate postpartum period. It is accepted Corresponding Author: Varsha Narayana Bhat, Department of
as a blind procedure where the operator is not able to visualize Obstetrics and Gynecology, Dr Shankarrao Chavan Government
the structure while piercing the abdomen with a trocar or Verres Medical College and Hospital, Nanded, Maharashtra, India, Phone: +91
needle. The approach requires an umbilical port and one or two 9740673416, e-mail: chvarshanbhat@gmail.com
additional 5-mm secondary ports to introduce various instruments. How to cite this article: Dulewad SS, Bhat VN, Koli PV. Is Previous
Many gynecologists are disquiet to perform the procedure in Abdominal or Pelvic Surgery a Risk Factor in Laparoscopic Sterilization?
women with previous abdominal or pelvic surgery as it is a relative A Retrospective Case Study. World J Lap Surg 2022;15(2):120–122.
contraindication as well as due to menace of postsurgical adhesions. Source of support: Nil
In addition, there are procedure-related risks of abdominal-cavity Conflict of interest: None
access techniques like gastrointestinal and major blood-vessel
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injuries, creation of pneumoperitoneum, and anesthesia-related
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risks. The present study has been conducted to evaluate the risk abortions, body mass index, and past medical and surgical history
involved, difficulties encountered, as well as techniques followed (history of cesarean sections, laparotomy for ectopic pregnancy,
to minimize the side effect in patients with previous abdominal or appendix, or any other major abdominopelvic surgery, etc.) were
pelvic surgery who are undergoing laparoscopic sterilization. noted.
Surgical Technique
MAterIAls And Methods The abdominal access process for conventional CO laparoscopy
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This retrospective study was conducted at the study institute. It is included 5 mm infraumbilical skin incision, insertion of the Veress
a tertiary care hospital as well as referral center for both public and needle into the peritoneal cavity through a blind approach, testing
private health sectors. The study included procedures performed the needle location and position, and insufflations of CO until an
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between January 2017 and January 2019. All the women were intraabdominal pressure of 12–14 mm Hg was obtained. Under
recontacted, informed consent was obtained, and they were direct vision, 5 mm ports were created lateral to the first entry
re-evaluated to analyze the rate of contraceptive failure after site. In total, 2–3 sites near the umbilicus were checked before
completing the second successful postoperative year. The study insertion of transumbilical trocar and after the attempts of two
included women who had requested for sterilization procedure. The failures systematically, trocar site was changed. Intraoperatively,
demographic and physical characteristics of the participant women fallopian tubes were identified, and nonreactive silastic ring was
included age, gravidity, parity, number of ectopic pregnancies and applied with the help of a specialized applicator device consisting

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