The Hulka Clip and the Tubal Ring

A follow-up study of 499 women who un'derwent sterilization between August 1973 and May 1976 at the Siriraj Hospital in Bangkok, Thailand, and had long-term (4-12 years post-surgery) follow-up is described. Women were sterilized through participation in one of three studies conducted at this hospital. In the first study, 124 underwent sterilization using the Hulka clip via laparoscopy; 67.7% of these women returned for a long-term follow-up visit. In the second study, 300 women wtre randomly allocated to the Hulka clip or to unipolar electrocoagulation (cautery) via laparoscopy; 70.7% of the women from this study returned for a long-term follow-up visit. The final study was a randomized trial comparing the tubal ring and unipolar electrocoagulation occlusion techniques in 300 cases. Long-term follow-up visits were recorded for 207 women (69.0%) from this study. Five technical failures (procedures not performed or completed as planned) and six non-interval cases were excluded from follow-up analyses. A total of 713 interval patients were eligible for follow-up. Long-term follow-up was initiated in 1978 and continued through 1986. Late sequelae of sterilization, including pregnancies and pelvic surgery, &re discussed with regard to type and time of tubal occlusion. One intrauterine and two ectopic pregnancies were reported among women who were sterilized with cautery; one ectopic prcgnancy was reported by a woman sterilized with the Hulka clip. Pelvic or abdominal surgeries were reported in 27 cases. Most (>98%) women indicated that they were satisfied with their sterilization procedure. contact for reprints Submitted for publication Hay 25, 1989 Accepted for publication October 3, 1989 JANUARY 1990 VOL. 41 NO. 1 9