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Safety and efficacy of hysteroscopic sterilization compared with laparoscopic sterilization: an observational cohort study

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h5162 (Published 13 October 2015) Cite this as: BMJ 2015;351:h5162

Rapid Response:

Re: Safety and efficacy of hysteroscopic sterilization compared with laparoscopic sterilization: an observational cohort study

I applaud the authors on giving us more information about sterilization procedures, but must caution our reaction to the "10 fold increase" in reoperation rates to real concrete numbers (162 out of 8048 hysteroscopy procedures or 2% of cases) as outlined in the attached table which is an acceptable and very low risk. We must be very careful to represent to our patients the risks and benefits, but avoid sensationalizing the statistical analysis that could potentially bias their decision making capacity. As we innovate more progressive minimally invasive devices and techniques for sterilization, we must remember that our current gold standard of laparoscopic sterilization came under scrutiny at its origin for major complications including organ perforations and thermal injury to other organs. The more important message here is that hysteroscopy procedures reduced major surgical procedures and exposure to general anesthesia in more than 15% of this initial study cohort which is a significant advance in the care of women desiring permanent sterilization while carrying a very small risk for re-operation.

Competing interests: No competing interests

16 October 2015
Mark B Woodland
Physician
Reading Health System
6th Avenue & Spruce Street, West Reading, PA19611