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Background: In 1996, the U.S. Collaborative Review of Sterilization (CREST) reported permanent contraception failure rates by method, but did not include the Filshie clip. Subsequent research provides data for Filshie clip failure rates up to 24 months, but rigorously designed and executed studies examining failure rates beyond 2 years are lacking. Objectives: To describe non-Filshie and Filshie procedures, identify failures, and calculate 10-year pregnancy rates among patients who have undergone interval permanent contraception procedures with Filshie clips. Study Design: We performed chart review for patients who underwent interval permanent contraception procedures between 2000 and 2014 at our institution. We identified births after permanent contraception by utilizing both chart review and the Utah Population Database. We report results from life table analysis, with censoring at failure, 49 years of age, or last observed date of service. Results: In this cohort of 693 patients, surgeons most commonly used Filshie clips for interval permanent contraception (N = 547, 78.8%). We classified pregnancies after Filshie clip procedures as verified (n = 4) or self-reported (n = 3). We obtained 5 years of data for 411 patients (59.3% of all permanent contraception procedures), and more than 10 years of data for 257 patients (37.1%). We calculated a cumulative 5- and 10-year pregnancy rate to be the same, including both verified and self-reported pregnancies, of 9.8 (95% confidence interval [CI] 4.1–23.3)/1000 women using Filshie clips. The 10-year rate of verified pregnancy is 2.8 (95% CI 1.0–15.7)/1000 women. Conclusion: Overall, long-term failure of Filshie clip interval permanent contraception procedures is infrequent, with a 10-year cumulative probability of failure of 4.1–23.3/1000 procedures performed. Filshie clips compare favorably with other methods of permanent contraception included in the CREST study, where the 10-year cumulative probability of failure ranged from 7.5 to 36.5/1000 procedures performed.

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.

The Filshie method is a tubal occlusion method commonly used to prevent pregnancy. In medical negligence cases where it is suspected that closure of a Filshie clip may be faulty, lawyers may call on expert surgeons to assess whether or not a clip is closed on the basis of visual examination of the X-rays. However, it is not uncommon for experts to disagree. The aim of this work was to reduce the uncertainty in determining whether or not Filshie clips had been correctly closed. An estimate of the error in the estimate of the clip height was made by propagating measurement errors through a mathematical model. The effects of angle of presentation of the clip, digitisation of the image and resolution of the measurements were studied and the method was applied to two cases. The analysis indicated that measurement errors were least when the digitisation of the image was at 600 dpi, angle of presentation of the clip was less than 40° and the measurements could be made to an accuracy of ±1 pixel. Under these conditions it was possible to determine clip closure height with an error of less than ±0.2 mm.

Introduction Tubal occlusion is a common form of contraception. Filshie clips have been widely used for tubal occlusion since their introduction. Reports of Filshie clip migration are rare. We describe what we believe to be the first reported case of a patient with multiple groin hernias associated with migration of a Filshie clip. Case presentation We report the case of 56-year-old Caucasian woman who presented with a tender right groin lump. She had undergone a right-sided inguinal hernia repair 3 years earlier. Tubal occlusion had been performed using Filshie clips 21 years prior. Computed tomography revealed a tubal clip within her right inguinal region, and had also been identified on imaging prior to a previous hernia repair. Our patient underwent repair of a right femoral hernia, with the tubal clip identified in the sac and removed. She has since had no recurrences. Conclusion Filshie clip migration is a rare event, with occasional complications occurring. This case highlights the importance of identification and removal of such foreign bodies, potentially reducing the risk of hernia recurrence or further complications.

This study was a long-term follow-up of patients in whom hysteroscopic tubal screws had been applied at the time of laparoscopic sterilization.Tubal screw application was performed before laparoscopic Filshie clip application. Follow-up ultrasonography was arranged 3, 6, and 9 months postoperatively to confirm retention. The tubal screws were removed hysteroscopically between 12 and 20 months after sterilization under local or light general anesthesia.Thirty-five women agreed to take part in the study. For the purpose of analysis, these patients were divided into an initial group (cases 1-20, group A) and a later group (cases 21-35, group B). Twenty-three patients had 41 tubal screws inserted (18 women had bilateral screw application). Twenty tubal screws were removed from 13 patients between 9 and 20 months after insertion, one screw remained in situ, and 20 screws had previously been extruded. Life table analysis plots demonstrated a marked but nonsignificant difference (P = .163) in the duration of tubal screw retention between the initial patients (group A) and the later patients (group B): 46.7% versus 76.9% at 6 months and 33% versus 61.5% at 12 months (P = .09 and P = .11, respectively).Our experience demonstrated improved application and retention with experience and refinement of the equipment; however, retention of the tubal screws, even in the later stages of development, was poor. A relatively noninvasive method of female sterilization remains the ideal, and further refinements are required.

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.

A 49-year-old female was electively admitted for a ventral incisional hernia repair. She had a laparotomy 10 years ago for adhesions and a preoperative MRI of the abdominal wall showed a hernia at the level of the umbilicus as well as a foreign body suture-like material related to previous surgery. Intraoperatively there was a loose Filshie clip external to the hernia sac presumably from …

Female sterilization is one of the commonest procedures performed worldwide. In 1999 around 50,000 female sterilizations were performed in England in the National Health Service (NHS) and charitable sectors [1 ]. The procedure is performed on mainly healthy women at their request, and the intention is to occlude each fallopian tube. This may be achieved through tubal surgical excision, application of a mechanical device, or electrocautery coagulation (Table 12.1). Where resources permit, the preferred and most widely established technique is laparoscopic tubal occlusion, which has, moreover, replaced the earlier technique of performing female sterilization via minilaparotomy. In the United Kingdom, the Royal College of Obstetricians and Gynaecologists (RCOG) recommends that laparoscopic sterilization be performed using either Filshie clip or ring [1]. Tubal excision and separation and related techniques (e.g., Pomeroy procedure) are preferred if sterilization is performed at cesar-ean delivery.

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.

Background: Gynecologic endoscopic procedures are increasingly common and require the ability to control large vascular structures. Method: The Filshie clip is a silicone-lined, titanium occlusive device, originally designed and Food and Drug Administration (FDA) approved for surgical contraception. This device also has the potential for occluding vascular structures during laparoscopic surgery. Experience and Results: We describe a salpingectomy, an excision of bilateral hydrosalpinges, and a salpingooopherectomy. We performed all procedures laparoscopically using this device as the primary modality for assuring hemostasis. Conclusion: The Filshie clip is a useful and economical device for assuring hemostasis during gynecologic endoscopic surgery.

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.

This report adds to the small, but significant, literature base describing late complications following laparoscopic sterilisation. In women with recalcitrant peri-anal sepsis (who have previously undergone a sterilisation procedure) the possibility of tubal clip migration should be borne in mind. This is also an important learning point from a medicolegal point of view as patients presenting with the sequelae of clip migration will need to be counselled, and possibly investigated, with respect to the efficacy of their sterilisation procedure.

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.

(2003). Migration of a Filshie clip into the urinary bladder with abscess formation. Pathology: Vol. 35, No. 4, pp. 356-357.

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.