Vaginal tubal ligation--is infection a significant risk?

Previous reports from the United States have shown that the morbidity and complication rates for vaginal sterilization are more than twice those for laparoscopic sterilization. Infection is usually reported to be the most frequent complication. This study reviews 329 cases from three private practitioners' offices to determine whether infection is, in fact, a significant risk in sterilization via colpotomy. Only six patients (1.8%) showed any evidence of pelvic infection, and all responded to antibiotics without requiring hospitalization. Hence, the risk of pelvic infection does not appear to be a deterrent to vaginal sterilization. Postoperative bleeding at the site of incision was reported in eight patients (2.4%), all of whom were treated as outpatients. Other complications that are reported and discussed do not negate the suitability of colpotomy sterilization as an outpatient procedure. An unsuspected and disturbing finding was a high subsequent pregnancy rate of 2.4%, which rose to 4.2% when the vaginal sterilization was combined with suction curettage. Since these rates are considerably higher than those reported for laparoscopic or laparotomy sterilizations, the selection of patients and the techniques employed for vaginal sterilization must be critically reviewed.