Obstet Gynecol Sci.  2017 May;60(3):296-302. 10.5468/ogs.2017.60.3.296.

Analysis of surgeries performed after hysteroscopic sterilization as tabulated from 3,803 Essure patient experiences

• Sills ES
• Li X
• Wood SH
• Jones CA

• KMID: 2378592
• DOI: http://doi.org/10.5468/ogs.2017.60.3.296

Abstract

OBJECTIVE
Although previous research has suggested that risk for reoperation among hysteroscopic sterilization (HS) patients is more than ten times higher than for patients undergoing standard laparoscopic tubal ligation, little has been reported about these subsequent procedures.
METHODS
This descriptive cohort study used a confidential online questionnaire to gather data from women (n=3,803) who volunteered information on HS followed by device removal surgery performed due to new symptoms developing after Essure placement.
RESULTS
In this sample, mean age was 35.6 years and women undergoing hysterectomy after HS comprised 64.9% (n=2,468). Median interval between HS and hysterectomy was 3.7 (interquartile range, 3.9) years and mean age at hysterectomy was 36.3 years. Some patients (n=1,035) sought removal of HS devices and fallopian tubes only, while other miscellaneous gynecological procedures were also occasionally performed for Essure-associated symptoms. When data from all patients who had any post-Essure surgery besides hysterectomy were aggregated (e.g., device removal +"other" cases, n=1,335) and compared to those cases undergoing hysterectomy, mean age was significantly lower than for the hysterectomy group (34.4 vs. 36.3 years, respectively; P<0.01); uterus-conserving surgeries were also typically performed significantly earlier than hysterectomy (P<0.01).
CONCLUSION
This investigation is the first to characterize specific gynecological operations after Essure, and suggests that the predominant surgical answer to HS complaints is hysterectomy for many women. Dissatisfaction with HS may represent an important indication for hysterectomy and additional study is needed to quantify this phenomenon.

Keyword

Contraception; Essure; Hysterectomy; Sterilization

MeSH Terms

Cohort Studies
Contraception
Device Removal
Fallopian Tubes
Female
Humans
Hysterectomy
Reoperation
Sterilization*
Sterilization, Tubal

Figure

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  Fig. 1 Distribution of procedures performed after hysteroscopic sterilization between 2002 and 2015 as determined from patient self-reports (n=3,803). In this sample, hysterectomy was performed significantly more often than any other operation subsequent to HS (P<0.01, by Student's t-test).

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  Fig. 2 Age distribution of patients who uhynstderoescrowpice stnertili zahtioyns wtiethr Eesscurteo (nm=2,y46 8). after hysteroscopic sterilization with Essure (n=2,468).

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  Fig. 3 Age distribution of patients who underwent device removal surgery (non-hysterectomy) after hysteroscopic sterilization with Essure (n=1,335).

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  Fig. 4 Kernal density estimation of inter-surgery intervals for hysteroscopic sterilization (HS) patients (n=3,803) who underwent additional surgery after Essure classified as hysterectomy (solid line) vs. non-hysterectomy (dashed line); P<0.01 by Mann-Whitney U-test.

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