We recently settled a claim from Mrs K, a mother of four, who had undergone laparoscopic sterilisation in 2000. During her sterilisation procedure, Dr B, a specialist gynaecologist, formed a pneumoperitoneum using standard techniques and carried out what seemed to be a routine procedure. Dr B’s operation note stated that he had applied Filshie clips to each fallopian tube.
Two months after this Mrs K became pregnant, giving birth to a healthy baby in late 2001. Three months later she asked a gynaecologist at another hospital to repeat her sterilisation. Mrs K underwent a laparoscopic bilateral salpingectomy.
A methylene-blue dye test was carried out and this showed that Mrs K had a patent right fallopian tube. The surgeon saw that the left tube was clipped, but that the right fallopian tube was not: he did see a clip on the anterior broad ligament, between the tube and the round ligament.
Mrs K brought a clinical negligence claim against Dr B. Dr B realised that he had placed the clips incorrectly once he had seen the operation note of the other surgeon. He was aware that at times the anatomical appearance could be confusing and that he had inadvertently placed the clips around the peritoneal structures rather than the tube itself.
Dr B accepted that he was liable for this mistake and agreed to the case being settled.
Tubal occlusion is not a fail-safe method of sterilisation. The counselling that patients receive before consenting to it should reflect this and be recorded in the notes. Diligent care must be taken so that you are sure that any occlusive devices applied to the tubes are correctly placed and functioning as designed.
If there is any doubt about this it is wise to try an alternative method of sterilisation, and ensure adequate contraception until this is achieved. Alternatively, you can confirm or refute tubal occlusion using investigation.
The UK Royal College of Obstetricians and Gynaecologists has recently published a comprehensive evidence-based guideline on male and female sterilisation.
Chapter Six, Tubal Occlusion, is recommended to those who carry out sterilisation by this method. There is also a summarised version, along with useful patient information leaflets for male and female sterilisation.
A paper in Medscape General Medicine looks at the implications of the American CREST* study
- CS Carignan, 'Tubal Occlusion Failures: Implications of the CREST Study on Reducing the Risk’, Medscape General Medicine (1997).
*Collaborative Review of Sterilization.