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Reliability of laparoscopic compared with hysteroscopic sterilization at 1 year: a decision analysis.

  • Author(s): Gariepy, Aileen M;
  • Creinin, Mitchell D;
  • Schwarz, Eleanor B;
  • Smith, Kenneth J
  • et al.
Abstract

To estimate the probability of successful sterilization after an hysteroscopic or laparoscopic sterilization procedure.

An evidence-based clinical decision analysis using a Markov model was performed to estimate the probability of a successful sterilization procedure using laparoscopic sterilization, hysteroscopic sterilization in the operating room, and hysteroscopic sterilization in the office. Procedure and follow-up testing probabilities for the model were estimated from published sources.

In the base case analysis, the proportion of women having a successful sterilization procedure on the first attempt is 99% for laparoscopic sterilization, 88% for hysteroscopic sterilization in the operating room, and 87% for hysteroscopic sterilization in the office. The probability of having a successful sterilization procedure within 1 year is 99% with laparoscopic sterilization, 95% for hysteroscopic sterilization in the operating room, and 94% for hysteroscopic sterilization in the office. These estimates for hysteroscopic success include approximately 6% of women who attempt hysteroscopically but are ultimately sterilized laparoscopically. Approximately 5% of women who have a failed hysteroscopic attempt decline further sterilization attempts.

Women choosing laparoscopic sterilization are more likely than those choosing hysteroscopic sterilization to have a successful sterilization procedure within 1 year. However, the risk of failed sterilization and subsequent pregnancy must be considered when choosing a method of sterilization.

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