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A multicentre trial was conducted to compare efficacy of postpartum sterilisation with clip and partial salpingectomy. Life-table estimates of pregnancy probabilities were compared through 2 years of follow up. A significantly different risk of pregnancy between the clip and partial salpingectomy groups was observed. Nine pregnancies were observed in the clip group versus two in the partial salpingectomy group. Cumulative probability of pregnancy through 2 years was 0.017 with the clip and 0.004 [correction added after online publication 25 September 2012; 0.044 has been replaced with 0.004] for partial salpingectomy (P < 0.04). Equivalent efficacy of the clip compared with partial salpingectomy has not been demonstrated in postpartum women.

To compare the failure rate (pregnancies) of a Pomeroy procedure and Filshie clips tubal occlusion at the time of Caesarean section. This is a retrospective observational study done in a district general hospital in the UK. There were 290 sterilisations performed at the time of Caesarean section over the period of 1994–2007. Studied population included 203 Pomeroy procedures and 87 Filshie clips applications. Follow-up period ranged from 2 to 15 years. A birth register and an operating theatre database were used to identify patients who underwent Caesarean section with a tubal occlusion. These patients’ names were checked against the antenatal booking database, the early pregnancy assessment unit database, the operating theatre database in case of ectopic pregnancies, and a termination of pregnancy database to recognise failed sterilisation. There was no failure of tubal occlusion with a Pomeroy procedure (0/203). The failure rate of Filshie clips tubal occlusion was 1.15% (1/87) (p = 0.3). The length of the follow-up period ranged from 2 to 15 years (for Pomeroy procedure, median was 9 years and inter-quartile range (IQR) was 7; for Filshie clip, median was 8 years and IQR was 7). Pomeroy technique appears to carry a lower risk of a failed sterilisation than Filshie clips tubal occlusion at the time of Caesarean section. However, Pomeroy procedure needs to be balanced against the speed and simplicity of Filshie clips tubal occlusion.

Since its introduction in 1981, the Filshie® clip (CooperSurgical, Trumbull, USA) has been widely accepted as safe and effective. Failure rates reported in the literature range from 0.23 to 0.40% (...

Introduction Incidental findings of pelvic pathology at the time of laparoscopic sterilization are not uncommon, and may necessitate additional instrumentation through a 5-mm port. We describe a simple and inexpensive method of adapting the Filshie clip applicator port to carry 5-mm instruments without losing gas pressure. When 5-mm instrumentation is required, the instrument is placed within the digit of a sterile glove and then inserted through the 7.5-mm Filshie clip applicator port. The glove digit remains within the port preventing gas escape whilst the instrument punctures the tip to emerge through the port to be used in the normal way. Results We report the results of a prospective study of 50 consecutive laparoscopies. Ease of use, gas leakage rates and complications are recorded. Having demonstrated the effectiveness of this technique, we evaluated its usefulness, by performing a retrospective case review of the operating notes of 50 consecutive laparoscopic sterilizations, recording the incidence of documented pelvic pathology and instrument use. Unexpected pathology was encountered in 13 cases (26%), and instruments were required in five (10%). Conclusions Incidental abnormalities within the pelvis are not uncommonly encountered at laparoscopic sterilization. Where instrumentation is required, our method allows utilization of the Filshie clip applicator port as an alternative to using a new 5-mm port. The system is cheap, safe and effective. One glove can provide digits for five separate insertions if necessary. We have found this temporary laparoscopic port-reducing method to be a simple and useful technique which meets the unexpected short-term need for instrument use at the time of laparoscopic sterilization.

The 6th International Scientific Meeting of the Royal College of Obstetricians and Gynaecologists (RCOG) took place in September 2005 in Cairo Egypt. During the meeting a sponsored symposium entitled The changing face of female sterilisation: meeting the needs of the 21st century woman (sponsored by Femcare-Nikomed Ltd manufacturer of the Filshie clip) provided an overview of the different methods of long-term contraception with a focus on female sterilisation. Here we report the main observations of the symposium including recommendations for factors that should be considered when assessing the long-term failure rates associated with female sterilisation. Over the past few decades rapid advances in technology have allowed the development of a number of different contraceptive methods that are available for use today. The choice of contraception is influenced by a number of factors including age sexual lifestyle relationship type family status and medical history. In addition as part of the necessary counselling of any family planning programme it is essential that provision of unbiased accurate information be provided so that women can make informed decisions on long-term contraception. (excerpt)

A prospective randomized comparison of the peri-operative complications and long-term sequelae between the Filshie clip and Pomeroy methods was undertaken in 200 postpartum women at Tri-Service General Hospital, Taipei, Taiwan. The peri-operative complications in either group were mild and infrequent. One pregnancy in the Pomeroy group was reported after follow-up for 24 months. No significant difference between the two groups was found in respect to long-term sequelae.

Objective To assess the failure rate of Filshie clip sterilisations in Victoria, Australia. Design Retrospective study between 1994 and 1998. Setting All specialist gynaecologists practising in the state of Victoria, Australia. Interventions Questionnaires (up to three) followed by telephone calls if necessary. Main outcome measures A response rate of 276/277 (99.6%) was obtained. All pregnancies were recorded. Results Seventy-three failures were notified from an estimated 30 000 Filshie clip sterilisations carried out in the study period. Conclusions The estimated failure rate of Filshie clip sterilisations in the state of Victoria carried out by specialist gynaecologists was between 2 and 3 per 1000 sterilisation operations.

This study is a review of 14 cases where laparoscopic oophorectomy was performed for women suffering from trapped ovary syndrome, in which the Filshie clip (Femcare, Nottingham, UK) was used to occlude the infundibulopelvic ligament prior to its division. All case records where this technique had been utilized were reviewed for the period commencing September 1991 until March 1994, involving 14 women, of median age 34 years and median parity 2. The main outcome measure was resolution of chronic pelvic pain at follow up. Of the women, 10 had previously undergone hysterectomy, and two others had previously required adhesiolyses. Symptoms had been present for 6–60 months (median 12). The mean theatre time was 103.3 min ± 29.8 (SEM); 11 had a unilateral and three a bilateral oophorectomy. The mean of the maximum diameter of specimen removed was 3.9 cm (range 2.5–6). The mean postoperative stay was 2.1 days (range 1–5). There were no serious complications. At follow up, all women reported improvement in their symptoms, with 11 reporting complete resolution of their pelvic pain. There was a good outcome in all 14 patients who had this minimal access surgical technique for trapped ovary syndrome. The Filshie clip is well suited to the purpose of infundibulopelvic ligament occlusion, being simple and easy to use. Most units possess Filshie clip applicators and trocars, and with a simple laparoscopic grasper and scissor would be equipped to perform this technique.

Tubal occlusion using Filshie clip is one of the most commonly performed operations for female sterilization. It is usually a simple and safe procedure, and operative complications are uncommon. We report a rare case of spontaneous expulsion of a Filshie clip through the anterior abdominal wall 5 years after sterilization. The management and possible underlying mechanisms are discussed and the related literature is reviewed.

EDITORIAL COMMENT": We accepted this case for publication to inform readers of the possibility of a pelvic abscess occurring associated with a clip on the Fallopian tube. A case of multiple pelvic abscesses due to actinomycosis was recently reported in this journal (A) that showed some similarities to the case here described. It is agreed that pelvic abscesses associated with a foreign body require removal of the foreign body but the reviewer of this paper also cautioned that recurrent pelvic abscesses may cause chronic pelvic inflammatory disease which requires further surgery such as hysterectomy and salpingo-oophorectomy. It is too early to conclude that this woman is cured of the pelvic infection. (A) Garland SM, Rawling D. Pelvic actinomycosis in association with an intrauterine device. Aust NZ J Obstet Gynaecol 1993; 33: 96–98.

An open Filshie clip is sometimes detected during the evaluation of a case of sterilisation failure. This spontaneous opening of the clip does not need to have been caused by material failure, but may be produced by jamming of the clip what can occur by incorrect squeezing during closure. On superficial observation, the clip will appear to be closed, but it may easily open itself by its spring mechanism when the clip is moved or merely touched. Especially in the teaching situation one should be careful for this lapse.

Laparoscopic tubal electrocoagulation continues to be widely practiced; however, mechanical devices such as the Yoon band, the Hulka clip, and, most recently, the Filshie clip are becoming more popular because of the avoidance of accidental electrical burns, the diminished likelihood of subsequent ectopic pregnancy, and, in the case of the clips, the minimal degree of tubal destruction, thus allowing for maximum reversibility. This survey of worldwide reports from 1981 to the present reveals a high level of acceptance of the Filshie clip because of its effective design and ease of application.

Laparoscopic Filshie clip sterilisation remains a common method of permanent female contraception. Worldwide, approximately 190 million couples use tubal occlusion (United Nations world population monitoring. United Nations, 2002). Trocar site incisional hernia has been reported as a complication of laparoscopic surgery where a 10-mm port was employed (Tonouchi et al. Arch Surg 139(11):1248–1256, 2004). It is common practice to repair port sites of 10 mm or more to prevent herniation. Port sites of 5 mm are not routinely repaired by most surgeons because it is thought that such iatrogenic fascial defects are not large enough to predispose to hernia (Reardon et al. J Laparoendosc Adv Surg Tech A 9(6):523–525, 1999). We report a rare case of early Filshie clip applicator port site intestinal obstruction following laparoscopic sterilisation. The mechanism of hernia formation and a preventive strategy are discussed.

Voluntary sterilization is a popular method of family size limitation. Among other techniques for surgical induction of female sterility, the application of various kinds of clips to the Fallopian tubes has been introduced. The Filshie clips consist of rubber-lined titanium and their use for interval sterilization has been repeatedly published. So far, there are only a few reports regarding the use of Filshie clips during the postpartum period, when tubes are edematous and more friable. Therefore, 300 women voluntarily requesting postpartum surgical sterilization for the purpose of family size limitation were enrolled into a prospective trial. Within 72 h of delivery, 282 women were sterilized under general anesthesia using a subumbilical minilaparotomy approach and Filshie clip application. Of these women, 251 were available for follow-up examination at 6 weeks, 240 at 6 months, 234 at 12 months, and 209 at 24 months after the sterilization procedure. Complication rates were low, and there were no pregnancies during the follow-up period. These results indicate that the application of Filshie clips is a safe and efficacious method of surgical female sterilization in the postpartum period.

An acute abdomen is a common diagnostic problem for physicians. A case is presented in which a Filshie clip had undergone torsion resulting in the presentation of an acute abdomen. This unusual complication should be considered in patients who present with abdominal pain following laparoscopic sterilization using Filshie clips.

SummaryTwo hundred and eighty-nine women requesting sterilisation were allocated at random to two groups for a prospective study. The object was to compare the perioperative difficulties and morbidity associated with sterilisation using either Filshie Mark VI or Hulka-Clemens clips. The Filshie clip was found to be superior to the Hulka-Clemens clip in ease of application and in its ability to occlude the tube in a satisfactory manner. The Filshie clip device was also simpler to maintain. Significant peri-operative pain occurred more frequently in the Hulka-Clemens group. The complication rate, both surgically related and method related, was low. There were no pregnancies in either group after 12 months follow up.

Female sterilization by the application of Filshe Clip Mark IV has been studied, on a prospective multicentric basis in 869 women for a period of two years. Sixty involuntary pregnancy following ligation were reported giving a failure rate of 8.6 per 100 women at the end of 24 months. Method failures were observed to be evenly distributed throughout the period of observation except in puerperal ligation in whom majority of the pregnancies occurred after six months following ligation. Failure rate was significantly higher in post-abortal ligations as compared to interval ligations. Due to unexpectedly higher failures rate further recruitment of study subjects was discontinued. Information on the status of the clip was available in only 30 of the sixty failures and the clips were in situ in only 4 cases, indicating improper application of clips. In view of high failure rates attributable to improper clip application, the method does not appear to be suitable for programmatic conditions in our country.

A comparative evaluation of three different techniques (Madlener's, Wood's and Filshie Clip Mark IV) for female sterilization was carried out in adult female rhesus monkeys with the aim of finding out the efficacy and the extent of tissue damage in the fallopian tube. The severity of pathological changes would indicate the chances of future successful reversal. The experiment was carried out in two phases. In Phase-I, no post-operative antibiotics were given whereas in Phase-II in addition to post-operative antibiotics, two sham-operated controls were also kept. This study revealed that the Filshie's clip is associated with significantly (p less than 0.01-0.001) greater tissue damage of the fallopian tubes with formation of dense adhesions as compared to the Madlener's or Wood's technique. Further, Filshie's clip had slipped off from 4 tubes out of 14 tubes where it was applied.