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Combination of Laparoscopic Sterilization with Abortion
Letters to the Editor
in isolated regions where LS has not been widely performed. References 1. Peterson HB, Xia Z, Hughes JM et al: The risk of preg-
nancy after tubal sterilization: Findings from U.S. collaborative review of sterilization. Am J Obstet Gynecol 174:1161-1170, 1996
Letters to the Editor
2. Singh E, Lindstrom R: The state of the world population: The new generation. Med Uzbekistan 1:2-5, 1999
Combination of Laparoscopic Sterilization with Abortion
3. Prilepskaya VN: Age-specific aspects of contraception. Obstet Gynecol Med 3:50--53, 1997 4. Asadov DA, Vaphakulova UB: Family planning in multipara women resided in country areas. Med Uzbekistan 3:5-8,2000
To the Editor: The frequency of laparoscopic tubal sterilization (LS) is high in most countries in the Western world. 1-3 In the Central Asian region and CIS countries performance of this popular procedure, especially in its modem minimally invasive approach, is unfairly low, although the fertility rate is very high and population growth remains high.v" We believe that extending LS to regions with a high rate of fertility and low rate of sterilization-about 1% of the reproductive-age population-would be beneficial. We succeeded in increasing sterilization rates by proposing LS to women seeking elective abortion. We performed simultaneous abortion and LS in 107 patients and compared results with those of 141 women undergoing traditional sterilization only. Laparoscopic sterilization was performed concomitantly with abortion safely and effectively in all 107 patients. There were no statistical differences between groups in procedure duration, recovery time, length of hospital stay, and time to resuming usual activities (p <0.05). The combined procedures did not lead to a rise in complication rate. All women accepted the surgery with enthusiasm and continued to express satisfaction during long-term follow-up. Despite this effective dual procedure, we found only a single reference to a similar approach in the literature.' Although some authors do not recommend simultaneous sterilization and abortion," we believe that the procedure as performed in our hospital challenges that view. We conclude that the combination is appropriate, technically achievable, and complication-free, and can be done successfully in regions with a high abortion rate and where abortion continues to be one method of family planning. In addition, it could become popular among women
5. Glukhov EU, Plotko YE, Levkovich MV et al: Experience of simultaneous performance of laparoscopic sterilization and artificial abortion. In Endoscopy in Gynecology. Edited by VI Kulakov, LV Adamyan. Moscow, Victoria Press, 1999, pp 181-182 6. Adamyan LV, Jabrailova S: Surgical sterilization in women: Basic Methods. In Endoscopy in Gynecology. Edited by VI Kulakov, LV Adamyan. Moscow, Victoria Press, 1999, pp 176-180
Alexander Kalegyn, M.D. Tashkent, Uzbekistan
Response: Tubal sterilization was initially performed at the time of cesarean delivery to avoid a second cesarean section. Today, however, most tubal sterilizations are elective, and it is estimated that in the United States alone more than 1 million of these procedures are performed annually. It is a highly effective method of preventing conception. It is also a safe operation with mortality of 1.5/100,000 procedures, a lower rate than that associated with pregnancy. Tubal sterilization is usually requested by women who wish a permanent method of contraception; these women are often 30 years of age or older and have completed childbearing.' Tubal sterilization by laparoscopy was started in the 1960s. With its widespread availability and acceptance, by mid-1980s, most tubal sterilizations in North America and western Europe were done by laparoscopy. Today, it is a standard procedure. However, as Dr. Kalegyn stated, in Central Asia it is still
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in isolated regions where LS has not been widely performed. References 1. Peterson HB, Xia Z, Hughes JM et al: The risk of preg-
nancy after tubal sterilization: Findings from U.S. collaborative review of sterilization. Am J Obstet Gynecol 174:1161-1170, 1996
Letters to the Editor
2. Singh E, Lindstrom R: The state of the world population: The new generation. Med Uzbekistan 1:2-5, 1999
Combination of Laparoscopic Sterilization with Abortion
3. Prilepskaya VN: Age-specific aspects of contraception. Obstet Gynecol Med 3:50--53, 1997 4. Asadov DA, Vaphakulova UB: Family planning in multipara women resided in country areas. Med Uzbekistan 3:5-8,2000
To the Editor: The frequency of laparoscopic tubal sterilization (LS) is high in most countries in the Western world. 1-3 In the Central Asian region and CIS countries performance of this popular procedure, especially in its modem minimally invasive approach, is unfairly low, although the fertility rate is very high and population growth remains high.v" We believe that extending LS to regions with a high rate of fertility and low rate of sterilization-about 1% of the reproductive-age population-would be beneficial. We succeeded in increasing sterilization rates by proposing LS to women seeking elective abortion. We performed simultaneous abortion and LS in 107 patients and compared results with those of 141 women undergoing traditional sterilization only. Laparoscopic sterilization was performed concomitantly with abortion safely and effectively in all 107 patients. There were no statistical differences between groups in procedure duration, recovery time, length of hospital stay, and time to resuming usual activities (p <0.05). The combined procedures did not lead to a rise in complication rate. All women accepted the surgery with enthusiasm and continued to express satisfaction during long-term follow-up. Despite this effective dual procedure, we found only a single reference to a similar approach in the literature.' Although some authors do not recommend simultaneous sterilization and abortion," we believe that the procedure as performed in our hospital challenges that view. We conclude that the combination is appropriate, technically achievable, and complication-free, and can be done successfully in regions with a high abortion rate and where abortion continues to be one method of family planning. In addition, it could become popular among women
5. Glukhov EU, Plotko YE, Levkovich MV et al: Experience of simultaneous performance of laparoscopic sterilization and artificial abortion. In Endoscopy in Gynecology. Edited by VI Kulakov, LV Adamyan. Moscow, Victoria Press, 1999, pp 181-182 6. Adamyan LV, Jabrailova S: Surgical sterilization in women: Basic Methods. In Endoscopy in Gynecology. Edited by VI Kulakov, LV Adamyan. Moscow, Victoria Press, 1999, pp 176-180
Alexander Kalegyn, M.D. Tashkent, Uzbekistan
Response: Tubal sterilization was initially performed at the time of cesarean delivery to avoid a second cesarean section. Today, however, most tubal sterilizations are elective, and it is estimated that in the United States alone more than 1 million of these procedures are performed annually. It is a highly effective method of preventing conception. It is also a safe operation with mortality of 1.5/100,000 procedures, a lower rate than that associated with pregnancy. Tubal sterilization is usually requested by women who wish a permanent method of contraception; these women are often 30 years of age or older and have completed childbearing.' Tubal sterilization by laparoscopy was started in the 1960s. With its widespread availability and acceptance, by mid-1980s, most tubal sterilizations in North America and western Europe were done by laparoscopy. Today, it is a standard procedure. However, as Dr. Kalegyn stated, in Central Asia it is still
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