1
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Leiter V. Signs and symptoms: Adverse events associated with a sterilization device. Soc Sci Med 2024; 351:116963. [PMID: 38759388 DOI: 10.1016/j.socscimed.2024.116963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 04/26/2024] [Accepted: 05/09/2024] [Indexed: 05/19/2024]
Abstract
Sterilization is now the most common contraceptive method used by women of in the U.S., and sterilization devices have played an important role in its increased popularity. This mixed methods study examines a random sample of 2500 U.S. Food and Drug Administration (FDA) adverse event reports made between 2006 and 2017 about Essure, a sterilization device. Quantitative coding was used to examine patient problems; pain and bleeding were reported most frequently. Qualitative coding analyzed impacts of symptoms on patients' everyday lives and patients' healthcare experiences, including intimate relationships, mothering, and paid employment. Findings suggest that some patients struggled when their reported "subjective" symptoms didn't result in "objective" clinical signs of problems, and when physicians dismissed or deflected their concerns in diagnostic encounters. This paper raises important issues regarding the symptoms patients associated with Essure, the diagnosis of device-driven disease and injury, and the FDA's regulation of medical devices.
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Affiliation(s)
- Valerie Leiter
- Department of Public Health, Simmons University, 300 The Fenway, Boston, MA, 02115, USA.
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2
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Sánchez-Cuerda C, Elices M, Lobo P, Cabrera Y, Duch S, García A, Rubio J, Álvarez J, Álvarez P. Cornual adenomyosis in Essure® device users and in patients hysterectomized for other causes: A retrospective cohort study. Int J Gynaecol Obstet 2024. [PMID: 38623939 DOI: 10.1002/ijgo.15541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/25/2024] [Accepted: 04/02/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVE To determine whether adenomyosis is present in the cornual portion of hysterectomies of symptomatic sterilization device users and in patients hysterectomized for different benign causes and who presented with pelvic pain and/or menstrual alterations. METHODS An observational, analytical, cross-sectional, single-center, retrospective cohort study was conducted in a secondary level hospital. Cohort 1 consisted of women who had Essure® hysteroscopic sterilization devices inserted between 2009 and 2017, who developed gynecologic symptoms (pelvic pain, heavy menstrual bleeding, and/or abnormal uterine bleeding) and who underwent a hysterectomy for explantation of the devices. Cohort 2 consisted of women with the same gynecologic symptoms, who underwent a hysterectomy for other benign causes. All surgeries were performed by the gynecology team between 2018 and 2022. A descriptive and comparative analysis of sociodemographic, clinical characteristics, and pathologic findings between cohorts was made. RESULTS In total, 96 patients were studied (cohort 1 included 34 women, cohort 2 included 62 women). Pelvic pain was found to be more frequent in the cohort of Essure users (76.47% vs. 50%, P = 0.012), with a ratio of three times higher in this group (odds ratio 3.25, 95% confidence interval 1.27-8.28). Adenomyosis was more frequently found in the Essure group, both at corporal and cornual portions, the latter being five times higher in this cohort (relative risk = 5.47; 95% confidence interval 1.17-25.64). CONCLUSIONS The present study may be the first to describe cornual adenomyosis related to Essure devices. These devices may play a role in the development of adenomyosis and, consequently, pelvic pain. However, causality is difficult to establish.
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Affiliation(s)
- Cristina Sánchez-Cuerda
- Department of Obstetrics and Gynecology, Infanta Sofía University Hospital, San Sebastián de los Reyes, Madrid, Spain
- European University Madrid, Villaviciosa de Odón, Madrid, Spain
| | - Margarita Elices
- Department of Anatomy Pathology, Infanta Sofía University Hospital, San Sebastián de los Reyes, Madrid, Spain
| | - Paloma Lobo
- Department of Obstetrics and Gynecology, Infanta Sofía University Hospital, San Sebastián de los Reyes, Madrid, Spain
- European University Madrid, Villaviciosa de Odón, Madrid, Spain
| | - Yasmina Cabrera
- Department of Obstetrics and Gynecology, Infanta Sofía University Hospital, San Sebastián de los Reyes, Madrid, Spain
- European University Madrid, Villaviciosa de Odón, Madrid, Spain
| | - Silvia Duch
- Department of Obstetrics and Gynecology, Infanta Sofía University Hospital, San Sebastián de los Reyes, Madrid, Spain
- European University Madrid, Villaviciosa de Odón, Madrid, Spain
| | - Alicia García
- Department of Obstetrics and Gynecology, Infanta Sofía University Hospital, San Sebastián de los Reyes, Madrid, Spain
| | - José Rubio
- Department of Obstetrics and Gynecology, Infanta Sofía University Hospital, San Sebastián de los Reyes, Madrid, Spain
- European University Madrid, Villaviciosa de Odón, Madrid, Spain
| | - Julio Álvarez
- Department of Obstetrics and Gynecology, Infanta Sofía University Hospital, San Sebastián de los Reyes, Madrid, Spain
- European University Madrid, Villaviciosa de Odón, Madrid, Spain
| | - Pilar Álvarez
- Department of Obstetrics and Gynecology, Infanta Sofía University Hospital, San Sebastián de los Reyes, Madrid, Spain
- European University Madrid, Villaviciosa de Odón, Madrid, Spain
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Li X, Feng Y, Gong Y, Chen Y. Assessing the Reproducibility of Research Based on the Food and Drug Administration Manufacturer and User Facility Device Experience Data. J Patient Saf 2024:01209203-990000000-00205. [PMID: 38470959 DOI: 10.1097/pts.0000000000001220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
OBJECTIVE This article aims to assess the reproducibility of Manufacturer and User Facility Device Experience (MAUDE) data-driven studies by analyzing the data queries used in their research processes. METHODS Studies using MAUDE data were sourced from PubMed by searching for "MAUDE" or "Manufacturer and User Facility Device Experience" in titles or abstracts. We manually chose articles with executable queries. The reproducibility of each query was assessed by replicating it in the MAUDE Application Programming Interface. The reproducibility of a query is determined by a reproducibility coefficient that ranges from 0.95 to 1.05. This coefficient is calculated by comparing the number of medical device reports (MDRs) returned by the reproduced queries to the number of reported MDRs in the original studies. We also computed the reproducibility ratio, which is the fraction of reproducible queries in subgroups divided by the query complexity, the device category, and the presence of a data processing flow. RESULTS As of August 8, 2022, we identified 523 articles from which 336 contained queries, and 60 of these were executable. Among these, 14 queries were reproducible. Queries using a single field like product code, product class, or brand name showed higher reproducibility (50%, 33.3%, 31.3%) compared with other fields (8.3%, P = 0.037). Single-category device queries exhibited a higher reproducibility ratio than multicategory ones, but without statistical significance (27.1% versus 8.3%, P = 0.321). Studies including a data processing flow had a higher reproducibility ratio than those without, although this difference was not statistically significant (42.9% versus 17.4%, P = 0.107). CONCLUSIONS Our findings indicate that the reproducibility of queries in MAUDE data-driven studies is limited. Enhancing this requires the development of more effective MAUDE data query strategies and improved application programming interfaces.
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Affiliation(s)
- Xinyu Li
- From the Department of Computer Science, Vanderbilt University, Nashville, Tennessee
| | - Yubo Feng
- From the Department of Computer Science, Vanderbilt University, Nashville, Tennessee
| | - Yang Gong
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, Texas
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Miguet-Bensouda C, Parant F, Grenet G, Cerruto E, Nohuz E, Chene G. Clinical improvement after Essure® devices removal: a systematic review. EUR J CONTRACEP REPR 2023:1-11. [PMID: 37466355 DOI: 10.1080/13625187.2023.2236741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 06/15/2023] [Accepted: 07/10/2023] [Indexed: 07/20/2023]
Abstract
PURPOSE Essure® implant is a permanently implanted minimally invasive birth control device for women (female sterilisation) widely used between 2002 and 2018. Many adverse events were reported by patients. Increasingly removal procedures have been performed in symptomatic patients. However, there is a lack of in-depth studies on clinical improvement after Essure® removal. We aimed to review all clinical studies about symptoms and quality of life (QoL) after removal procedures. MATERIALS AND METHODS A review of literature in electronic search in Medline and Embase databases from January 2002 to January 2022 using the following keywords: Essure; Essure removal; quality of life; symptomatology improvement. RESULTS Out of 764 articles in the initial database, 18 clinical studies were eligible for inclusion in our literature review. Overall clinical improvement rates after removal ranged from 21% to 98%. All symptoms were less frequent after Essure® removal, although with large discrepancies between studies. Lack of improvement was reported between 1% to 15% of patients. Rate of patients with improvement of QoL after removal ranged from 58 to 98%. The pain was reported as significantly reduced after the surgery. CONCLUSIONS In the available literature, Essure® removal in symptomatic patients may improve symptoms and quality of life. This should be discussed in the benefits and risks ratio before deciding on the best option of management.
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Affiliation(s)
- Chloe Miguet-Bensouda
- Department of Gynecology, Hôpital Femme Mère Enfant, HFME, University Hospital of Lyon, Lyon, France
| | - Francois Parant
- Trace Element Analysis Laboratory, Biochemistry Department, CBAPS, Centre hospitalier Lyon-Sud, Chemin du Grand-Revoyet, University hospital of Lyon, Pierre-Benite, France
| | - Guillaume Grenet
- Department of Pharmacotoxicology, University Hospital of Lyon, Lyon, France
| | - Emanuele Cerruto
- Department of Gynecology, Hôpital Femme Mère Enfant, HFME, University Hospital of Lyon, Lyon, France
| | - Erdogan Nohuz
- Department of Gynecology, Hôpital Femme Mère Enfant, HFME, University Hospital of Lyon, Lyon, France
| | - Gautier Chene
- Department of Gynecology, Hôpital Femme Mère Enfant, HFME, University Hospital of Lyon, Lyon, France
- Claude Bernard university of Lyon 1, Lyon, France
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Analysis of clinical data associated with Essure® sterilization devices: An expanded case series. Eur J Obstet Gynecol Reprod Biol 2022; 278:125-130. [PMID: 36166976 DOI: 10.1016/j.ejogrb.2022.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 08/29/2022] [Accepted: 09/18/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To evaluate clinical data in women who underwent Essure® hysteroscopic sterilization and to determine whether this sterilization technique plays a role in developing new-onset symptoms. STUDY DESIGN An observational, retrospective, single-center study. It was conducted in a secondary level hospital. It included 804 women who had Essure® hysteroscopic sterilization from 2009 to 2017. Charts from these women were reviewed from June 2009 to November 2019, searching for the development of gynecological symptoms (pelvic pain and bleeding disorders) and non-gynecological symptoms (bloating, joint pain, fatigue, headache, alopecia, allergy and depression). The sample was divided into two groups depending on whether they had developed gynecological symptoms (symptomatic group) or not (asymptomatic group), and a descriptive and comparative analysis was made between them. The impact of the global social alarm in 2015 regarding adverse events attributed to the devices, the development of non-gynecological symptoms, and the treatments required, including conservative and surgical options, were also described. RESULTS Out of 804 women who had Essure® devices placed, 541(67.29%) remained asymptomatic, 263(32.71%) developed gynecological symptoms, and 41 of these (15.5% of the total sample) requested Essure® surgical removal. Pelvic pain was the most frequent symptom and the main reason for surgical removal. Bleeding alterations were the second most frequent symptom. Up to 55.89% described the symptoms after the social alarm. Non-gynecological symptoms were statistically significantly more frequent in the symptomatic group. CONCLUSIONS More than a half of the women who underwent Essure® sterilization remained asymptomatic. The new-onset symptoms attributed to the devices are the minority and causality is difficult to establish. IMPLICATIONS STATEMENT Our research provides new follow-up data about Essure® hysteroscopic sterilization. Association between gynecological symptoms and Essure® devices is difficult to demonstrate and some confounding factors may be implicated. The results we described, may guide and counsel medical-patient decisions for the treatment of symptoms related to the devices, including surgical removal.
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Dernoncourt A, Serpier M, Gagneur O, Roman H, El Balkhi S, Bodeau S, Schmidt J. "Fibromyalgia syndrome" related to Essure devices. Autoimmun Rev 2021; 21:102959. [PMID: 34560303 DOI: 10.1016/j.autrev.2021.102959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 09/19/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Amandine Dernoncourt
- Department of Internal Medicine, Amiens-Picardie University Medical Center, Amiens, France; RECIF, Amiens-Picardie University Medical Center, Amiens, France.
| | - Marine Serpier
- Department of Internal Medicine, Amiens-Picardie University Medical Center, Amiens, France; RECIF, Amiens-Picardie University Medical Center, Amiens, France
| | - Odile Gagneur
- Department of Gynecology and Obstetrics, Amiens-Picardie University Medical Center, Amiens, France
| | - Horace Roman
- Endometriosis Centre, Tivoli-Ducos Clinic, Bordeaux, France; Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Souleiman El Balkhi
- Department of Pharmacology, Toxicology and Pharmacovigilance, Limoges University Hospital, Limoges, France
| | - Sandra Bodeau
- Laboratory of Pharmacology and Toxicology and Team MP3CV, EA 7517, Amiens-Picardie University Medical Center, Amiens, France
| | - Jean Schmidt
- Department of Internal Medicine, Amiens-Picardie University Medical Center, Amiens, France; RECIF, Amiens-Picardie University Medical Center, Amiens, France
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7
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Jegaden M, Pourcelot AG, Fernandez H, Capmas P. Surgical removal of essure® micro inserts by vaginal hysterectomy or laparoscopic salpingectomy with cornuectomy: Case series and follow up survey about device-attributed symptoms resolution. J Gynecol Obstet Hum Reprod 2020; 49:101781. [DOI: 10.1016/j.jogoh.2020.101781] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 04/14/2020] [Accepted: 04/17/2020] [Indexed: 01/24/2023]
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Challenges in Removing the Essure ® Device. Case Rep Obstet Gynecol 2020; 2020:8823606. [PMID: 32908744 PMCID: PMC7468664 DOI: 10.1155/2020/8823606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 08/10/2020] [Indexed: 11/17/2022] Open
Abstract
We present a case about Essure® removal surgery in which the third markers of the device have torn off. The woman needed a second surgery for complete removal of the devices. Fluoroscopy during surgery is a good method to visualize the lost fragments. With fluoroscopy, a hysterectomy is not needed for complete removal. It is important to understand the structure of the device and to be aware of the four radiopaque markers during surgery and their removal.
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Leleu A, Cathelain A, Rubod C, Vandendriessche D, Cosson M, Giraudet G. Symptom related to Essure® and evolution after removal: Outcomes of retrospective cohort. J Gynecol Obstet Hum Reprod 2020; 50:101836. [PMID: 32590111 DOI: 10.1016/j.jogoh.2020.101836] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 05/25/2020] [Accepted: 06/12/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The number of requests for Essure removal has grown continually over recent years. The objective is to describe the symptoms reported after Essure sterilization, methods of removal and results. MATERIAL AND METHODS Retrospective and single-centre cohort (Regional university hospital of Lille, France) was conducted. All women, having consulted from December 2016 to February 2019 for symptoms related to Essure insertion, were included. All the symptoms were noted. A second group was created that included patients who underwent Essure removal to evaluate the benefits of surgery on these symptoms. RESULTS The study included 98 patients. Most frequent symptoms were musculoskeletal pain (75 %), asthenia (63 %) and pelvic pain (55 %). Fifty-nine patients (60 %) underwent surgery. Surgery appeared beneficial with reduction of symptoms in 60 % of these patients, complete resolution in 33 % and no reduction of symptoms in 7%. Many symptoms were relieved by surgery with an overall decline of 96 % in menorrhagia, 94 % in metrorrhagia and 93 % in dyspareunia. However, other symptoms were not relieved by surgery like 100 % of sleep disorders, 70 % of abdominal pain cases and 57 % of memory impairment cases. CONCLUSION Symptoms related to Essure insertion are numerous. Although surgery appears beneficial, some adverse effects remain. Therefore, a preoperative aetiologic assessment and information about risk of surgery failure are important.
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Affiliation(s)
- A Leleu
- CHU Lille, Gynaecological Surgery Department, F-59000, Lille, France
| | - A Cathelain
- CHU Lille, Gynaecological Surgery Department, F-59000, Lille, France
| | - C Rubod
- CHU Lille, Gynaecological Surgery Department, F-59000, Lille, France; University of Lille, F-59000, Lille, France
| | - D Vandendriessche
- CHU Lille, Gynaecological Surgery Department, F-59000, Lille, France
| | - M Cosson
- CHU Lille, Gynaecological Surgery Department, F-59000, Lille, France; University of Lille, F-59000, Lille, France
| | - G Giraudet
- CHU Lille, Gynaecological Surgery Department, F-59000, Lille, France.
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Arora R, Shapiro H, Liu K, Arthur R, Cruickshank B, Sharma P, Glass K, Baratz A, Librach C, Greenblatt EM. Safety and Assisted Reproductive Technology Outcomes of Hysteroscopic Tubal Microinserts Versus Laparoscopic Proximal Tubal Occlusion or Salpingectomy for Hydrosalpinges Treatment. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 42:779-786. [PMID: 32224160 DOI: 10.1016/j.jogc.2019.11.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 11/11/2019] [Accepted: 11/14/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study sought to answer the following question: What are the complications and assisted reproductive technology outcomes among women with hydrosalpinges managed by hysteroscopic microinsert tubal occlusion compared with women with hydrosalpinges managed by laparoscopic proximal tubal occlusion or salpingectomy? METHODS This was a retrospective cohort study conducted from January 2009 to December 2014 at two academic, tertiary care, in vitro fertilization centres in Toronto, Ontario. All patients (n = 52) who underwent hysteroscopic tubal occlusion for hydrosalpinges were identified. Patients who proceeded with embryo transfer cycles after hysteroscopic microinsert (n = 33) were further age matched to a cohort of patients who underwent embryo transfer after laparoscopic proximal tubal occlusion or salpingectomy (n = 33). Main outcome measures were clinical pregnancy rate per patient and per embryo transfer cycle. RESULTS Among 33 patients, there were 39 fresh and 37 frozen embryo transfer cycles in the hysteroscopic group (group A); among 33 patients in the laparoscopic group (group B), there were 42 fresh and 29 frozen embryo transfer cycles. The cumulative clinical pregnancy rate in group A and group B was similar (66.7% vs. 69.7%, respectively; P = 0.8). The clinical pregnancy rate per embryo transfer cycle was also similar in both groups (28.9% in group A vs. 32.4% in group B; P = 0.6). There were two incidents of ectopic pregnancy in the laparoscopic group and no ectopic pregnancy in the hysteroscopic group. There were three major complications: tubo-ovarian abscess, distal migration of the coil after microinsert placement, and an acute abdomen following the hysteroscopic procedure. CONCLUSION Pregnancy outcomes after hysteroscopic placement of a microinsert for hydrosalpinx management before embryo transfer were comparable to those following laparoscopic proximal tubal occlusion or salpingectomy. However, caution is advised regarding microinsert placement for hydrosalpinges before proceeding with assisted reproductive technology.
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Affiliation(s)
- Ritika Arora
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON
| | - Heather Shapiro
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON; Mount Sinai Fertility, Mount Sinai Hospital, Toronto, ON
| | - Kimberly Liu
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON; Mount Sinai Fertility, Mount Sinai Hospital, Toronto, ON
| | - Rebecca Arthur
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON; Mount Sinai Fertility, Mount Sinai Hospital, Toronto, ON
| | - Barbara Cruickshank
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON; Mount Sinai Fertility, Mount Sinai Hospital, Toronto, ON
| | - Prati Sharma
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON; CReATe Fertility Centre, Toronto, ON
| | - Karen Glass
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON; CReATe Fertility Centre, Toronto, ON
| | - Ari Baratz
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON; CReATe Fertility Centre, Toronto, ON
| | - Clifford Librach
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON; CReATe Fertility Centre, Toronto, ON
| | - Ellen M Greenblatt
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON; Mount Sinai Fertility, Mount Sinai Hospital, Toronto, ON.
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Merviel P, Kurtz D, Lelievre C, Le Gourrierec A, Postec-Ollitrault E, Dupré PF. Assessment of non-gynecological symptoms before and after removal of the Essure® sterilization device: a 6-month follow-up study. MINERVA GINECOLOGICA 2020; 71:404-411. [PMID: 32064824 DOI: 10.23736/s0026-4784.19.04391-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Most of the clinical adverse events associated with the Essure® sterilization device have been attributed to incidents during and immediately after device placement (perforation, infection, expulsion). The aim of this study was to prospectively evaluate the prevalence and severity of non-gynecological clinical symptoms (e.g. memory disorders, muscle pain, and impaired vision) in patients before device placement and after device removal. METHODS Women who presented at least four non-gynecological clinical symptoms with the Essure® filled out a questionnaire before surgical removal of the device and then 1, 3 and 6 months afterwards. Patients with bleeding (metrorrhagia and menorrhagia) or tube perforation were excluded. RESULTS Fifty-two symptomatic women were included in the study and followed up for 6 months. The median (range) time interval between Essure® placement and the first clinical symptom was 13 months (1-60), and the median time interval between Essure® placement and removal was 38 months (12-72). The prevalence of clinical symptoms prior to device removal ranged from 26% (for urinary tract disorders) to 96% (for weakness). The mean±standard deviation intensity (on a 0-to-10 scale) of the symptoms before removal of the Essure® was 8.4±0.4; at 1 month, 3 months and 6 months post-removal, the values had fallen significantly to 4.2±0.6, 4±0.8, and 4.1±1, respectively (P<0.0001 for all the symptoms). CONCLUSIONS The observed decrease in symptom frequency and severity following Essure® removal and the persistence of this effect at 6 months suggest that the device should be removed in all symptomatic women.
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Affiliation(s)
- Philippe Merviel
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Hospital of Brest, Brest, France -
| | - Dorothee Kurtz
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Hospital of Brest, Brest, France
| | - Caroline Lelievre
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Hospital of Brest, Brest, France
| | - Anne Le Gourrierec
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Hospital of Brest, Brest, France
| | - Edith Postec-Ollitrault
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Hospital of Brest, Brest, France
| | - Pierre-François Dupré
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Hospital of Brest, Brest, France
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Cho YK, Nguyen S, Harkins G, Deimling T, Benton A. An Analysis of Patients Undergoing Surgical Removal of the Essure Device: A Retrospective Case Series. J Gynecol Surg 2019. [DOI: 10.1089/gyn.2018.0111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Yonghee K. Cho
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Samantha Nguyen
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Gerald Harkins
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Timothy Deimling
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Andrea Benton
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Penn State Milton S. Hershey Medical Center, Hershey, PA
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Charavil A, Agostini A, Rambeaud C, Schmitt A, Tourette C, Crochet P. Vaginal Hysterectomy with Salpingectomy for Essure Insert Removal. J Minim Invasive Gynecol 2019; 26:695-701. [DOI: 10.1016/j.jmig.2018.07.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 07/18/2018] [Accepted: 07/23/2018] [Indexed: 10/28/2022]
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Kim AJ, Barberio A, Berens P, Chen HY, Gants S, Swilinski L, Acholonu U, Chang-Jackson SC. The Trend, Feasibility, and Safety of Salpingectomy as a form of Permanent Sterilization. J Minim Invasive Gynecol 2019; 26:1363-1368. [PMID: 30771489 DOI: 10.1016/j.jmig.2019.02.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 02/05/2019] [Accepted: 02/07/2019] [Indexed: 10/27/2022]
Abstract
STUDY OBJECTIVE To assess the change in the rate of laparoscopic salpingectomy for sterilization after the release of the November 2013 Society of Gynecologic Oncology Clinical Practice Statement and the January 2015 American College of Obstetricians and Gynecologists Committee Opinion: Salpingectomy for Ovarian Cancer Prevention. We hypothesized there would be an increase in salpingectomy as a percentage of total laparoscopic sterilizations performed without an increase in complications when compared with conventional bilateral tubal ligation (BTL). DESIGN A retrospective cohort study. SETTING Four university-affiliated hospitals in Houston, TX, and New York, NY. PATIENTS All women 21 years or older who underwent interval laparoscopic permanent sterilization between April 2013 and September 2016. INTERVENTIONS Sterilization by bilateral salpingectomy or conventional tubal ligation. MEASUREMENTS AND MAIN RESULTS There were 454 sterilization procedures identified; 60% were BTLs, whereas 40% were salpingectomies. The rate of use of salpingectomy significantly increased from 5% to 9% in 2013 to 2014 to 78% by 2016. There was no significant difference in intraoperative or postoperative complications or estimated blood loss. The mean procedure time was 54 minutes for salpingectomy compared with 45 minutes for BTL (p <.0001). Salpingectomy was more likely to require 3 ports compared with 2 ports for BTL (p <.0001). CONCLUSIONS The Society of Gynecologic Oncology and the American College of Obstetricians and Gynecologists' support of salpingectomy for ovarian cancer prevention increased its use for sterilization. Based on this study, laparoscopic bilateral salpingectomy is a safe method of sterilization without an increase in perioperative risk compared with conventional tubal ligation. Physicians should incorporate these findings and implications when counseling patients regarding contraception and permanent sterilization.
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Affiliation(s)
- Annie J Kim
- Department of Obstetrics and Gynecology, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas (Drs. Kim, Berens, Chen, Gants, Swilinski, and Chang-Jackson).
| | - Andrea Barberio
- Department of Obstetrics and Gynecology, New York Presbyterian Hospital/Weill Cornell, New York, New York (Drs. Barberio and Acholonu)
| | - Pamela Berens
- Department of Obstetrics and Gynecology, New York Presbyterian Hospital/Weill Cornell, New York, New York (Drs. Barberio and Acholonu)
| | - Han-Yang Chen
- Department of Obstetrics and Gynecology, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas (Drs. Kim, Berens, Chen, Gants, Swilinski, and Chang-Jackson)
| | - Shavonia Gants
- Department of Obstetrics and Gynecology, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas (Drs. Kim, Berens, Chen, Gants, Swilinski, and Chang-Jackson)
| | - Lisa Swilinski
- Department of Obstetrics and Gynecology, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas (Drs. Kim, Berens, Chen, Gants, Swilinski, and Chang-Jackson)
| | - Uchenna Acholonu
- Department of Obstetrics and Gynecology, New York Presbyterian Hospital/Weill Cornell, New York, New York (Drs. Barberio and Acholonu)
| | - Shao-Chun Chang-Jackson
- Department of Obstetrics and Gynecology, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas (Drs. Kim, Berens, Chen, Gants, Swilinski, and Chang-Jackson)
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15
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Clark NV, Endicott SP, Jorgensen EM, Hur HC, Lockrow EG, Kern ME, Jones-Cox CE, Dunlow SG, Einarsson JI, Cohen SL. Review of Sterilization Techniques and Clinical Updates. J Minim Invasive Gynecol 2018; 25:1157-1164. [DOI: 10.1016/j.jmig.2017.09.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 09/09/2017] [Accepted: 09/11/2017] [Indexed: 12/19/2022]
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16
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Baltus T, Brown J, Mahmoud I. Delayed systemic allergic dermatitis following Essure insert: A case report. Case Rep Womens Health 2018; 20:e00075. [PMID: 30225200 PMCID: PMC6139599 DOI: 10.1016/j.crwh.2018.e00075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 08/25/2018] [Accepted: 08/29/2018] [Indexed: 11/18/2022] Open
Abstract
Hypersensitivity reaction to the nickel component of the Essure contraceptive micro-insert (Essure) is extremely rare. We present a case of a 41-year-old woman who reported a delayed systemic allergic reaction to the Essure. This is the fourth such case to be reported in the literature. Four years after Essure insertion, the patient developed systemic contact dermatitis secondary to the nickel component. The Essure was suspected as the cause after a positive allergy-patch test result for nickel. An initial laparoscopic bilateral salpingectomy did not improve her symptoms (likely due to retained microfilament), but a subsequent hysterectomy resulted in complete resolution of symptoms. Nickel allergy is a rare but serious complication of the Essure and practitioners should be cognisant of its role in hypersensitivity reactions. Hypersensitivity to the nickel component of Essure is an extremely rare occurence. We present the fourth case of systemic contact dermatitis following Essure insert. Subsequent removal of the device led to complete symptom resolution.
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Affiliation(s)
- Tanja Baltus
- Department of Women's and Newborn Health, Westmead Hospital, Cnr Hawkesbury Road and Darcy Road, Western Sydney Local Health District, Westmead, NSW 2145, Australia
- Corresponding author.
| | - James Brown
- Department of Women's and Newborn Health, Westmead Hospital, Cnr Hawkesbury Road and Darcy Road, Western Sydney Local Health District, Westmead, NSW 2145, Australia
| | - Imad Mahmoud
- Department of Women's and Newborn Health, Auburn Hospital, 18/20 Hargrave Road, Auburn, NSW 2144, Australia
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17
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Wahl H, Bell J, Skinner B. Laparoscopic Removal of a Retroperitoneal Hysteroscopic Microinsert Using Fluoroscopy. J Minim Invasive Gynecol 2017; 24:174-176. [PMID: 27687852 DOI: 10.1016/j.jmig.2016.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 09/15/2016] [Accepted: 09/18/2016] [Indexed: 11/16/2022]
Abstract
Perforation during placement of hysteroscopic microinserts for permanent sterilization occurs in approximately .9% to 2.6% of women undergoing the procedure. Most of the time perforation results in intraperitoneal placement of the hysteroscopic microinsert requiring laparoscopy or laparotomy for removal of the device. Herein we present a case of hysteroscopic microinsert perforation with subsequent retroperitoneal identification of the device. This is the first such case to our knowledge of retroperitoneal identification and retrieval of a perforated device that required real-time fluoroscopy during laparoscopy.
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Affiliation(s)
- Heather Wahl
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan.
| | - Jason Bell
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan; Program on Women's Health Care Effectiveness Research, University of Michigan, Ann Arbor, Michigan
| | - Bethany Skinner
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan; Division of Minimally Invasive Surgery, University of Michigan, Ann Arbor, Michigan
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18
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Does Essure Cause Significant De Novo Pain? A Retrospective Review of Indications for Second Surgeries After Essure Placement. J Minim Invasive Gynecol 2016; 23:1158-1162. [DOI: 10.1016/j.jmig.2016.08.823] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 08/15/2016] [Accepted: 08/18/2016] [Indexed: 11/19/2022]
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19
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The Role of Social Networks, Medical–Legal Climate, and Patient Advocacy on Surgical Options. Obstet Gynecol 2016; 127:758-762. [DOI: 10.1097/aog.0000000000001335] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Twelve-year retrospective review of unintended pregnancies after Essure sterilization in the Netherlands. Fertil Steril 2016; 105:932-7. [DOI: 10.1016/j.fertnstert.2015.12.129] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 12/21/2015] [Accepted: 12/22/2015] [Indexed: 11/23/2022]
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21
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Hoyos LR, Leon-Peters J, Berman JM, Hertz M. Pregnancy following hysteroscopic sterilization at an Urban Abortion Clinic- A case series: Are We looking in the wrong places? Contraception 2016; 94:78-80. [PMID: 27000998 DOI: 10.1016/j.contraception.2016.02.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 02/22/2016] [Accepted: 02/28/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Hysteroscopic sterilization (HS) has become one of the most common permanent contraception methods in the U.S. However, recent evidence suggests that the failure rate may be higher than previously reported. We describe women with a history of HS presenting for abortion at a 3-site urban abortion clinic. STUDY DESIGN Retrospective case series of patients with previous HS who presented to a 3-site urban abortion clinic for pregnancy termination from October 2012 to February 2015. RESULTS In 28months, 9 patients with prior HS had failure of the method and then an abortion. CONCLUSIONS This study identifies a number of failures from a setting previously unaccounted. It suggests that perhaps the failure rate is higher than previously reported. The cases here presented, from a 3-site urban abortion clinic over 28months, almost match and sometimes surpass the number of failures reported in multicenter case series in the literature. Surveys of other abortion clinics in the U.S. and elsewhere might also discover other patients whose HS had failed. IMPLICATIONS We identified a number of hysteroscopic sterilization failures at termination of pregnancy at a 3-site urban abortion clinic. We hypothesize that the HS failure rate underestimates the true method failure because previous analysis have excluded cases such as these.
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Affiliation(s)
- Luis R Hoyos
- Department of Obstetrics & Gynecology, Wayne State University/Hutzel Women's Hospital, 3990 John R, 7-Brush N, Mail Box 165, Detroit, MI, 48201, USA.
| | - Jocelyn Leon-Peters
- Department of Obstetrics & Gynecology, Wayne State University/Hutzel Women's Hospital, 3990 John R, 7-Brush N, Mail Box 165, Detroit, MI, 48201, USA.
| | - Jay M Berman
- Department of Obstetrics & Gynecology, Wayne State University/Hutzel Women's Hospital, 3990 John R, 7-Brush N, Mail Box 165, Detroit, MI, 48201, USA.
| | - Michael Hertz
- Department of Obstetrics & Gynecology, Wayne State University/Hutzel Women's Hospital, 3990 John R, 7-Brush N, Mail Box 165, Detroit, MI, 48201, USA.
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22
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Essure Surgical Removal and Subsequent Resolution of Chronic Pelvic Pain: A Case Report and Review of the Literature. Case Rep Obstet Gynecol 2016; 2016:6961202. [PMID: 26904330 PMCID: PMC4745314 DOI: 10.1155/2016/6961202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 12/31/2015] [Accepted: 01/03/2016] [Indexed: 11/18/2022] Open
Abstract
Background. Hysteroscopic tubal sterilization (Essure) is a minimally invasive option for permanent contraception with high reported rates of patient satisfaction. A small percentage of these women subsequently choose to have the tubal inserts removed due to regret or perceived side effects such as late-onset pelvic pain secondary to placement of the Essure device. Case. A twenty-nine-year-old woman G4P4014 presented with a two-year complaint of chronic pelvic pain and dyspareunia after the hysteroscopic placement of an Essure device for sterilization. On reviewing the images of the HSG, it was noted that although tubal occlusion was confirmed, the left Essure coil appeared curved on itself in an elliptical fashion and did not seem to follow the expected anatomic trajectory of the fallopian tube. The patient reported resolution of chronic pelvic pain following laparoscopic removal of Essure device. Conclusion. A misplaced Essure device should be considered in the differential diagnosis of chronic pelvic pain in women who had difficult placement of the device. In addition to demonstrating tubal occlusion, careful examination of the configuration of the Essure microinserts on HSG examination provides valuable information in patients with pelvic pain after Essure placement.
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23
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Complications of hysteroscopy and how to avoid them. Best Pract Res Clin Obstet Gynaecol 2015; 29:982-93. [DOI: 10.1016/j.bpobgyn.2015.03.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 03/18/2015] [Indexed: 11/21/2022]
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24
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Chudnoff SG, Nichols JE, Levie M. Hysteroscopic Essure Inserts for Permanent Contraception: Extended Follow-Up Results of a Phase III Multicenter International Study. J Minim Invasive Gynecol 2015; 22:951-60. [DOI: 10.1016/j.jmig.2015.04.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 04/16/2015] [Accepted: 04/19/2015] [Indexed: 10/23/2022]
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25
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Brito LGO, Cohen SL, Goggins ER, Wang KC, Einarsson JI. Essure Surgical Removal and Subsequent Symptom Resolution: Case Series and Follow-Up Survey. J Minim Invasive Gynecol 2015; 22:910-3. [DOI: 10.1016/j.jmig.2015.03.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 03/27/2015] [Accepted: 03/31/2015] [Indexed: 10/23/2022]
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26
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Veersema S. Hysteroscopy and contraception. Best Pract Res Clin Obstet Gynaecol 2015; 29:940-50. [PMID: 26013880 DOI: 10.1016/j.bpobgyn.2015.03.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 03/18/2015] [Indexed: 10/23/2022]
Abstract
The Essure method is the only available hysteroscopic sterilisation method. A 4-cm device is placed in the fallopian tubes, which then induces an inflammatory reaction that causes occlusion. The method has a high successful placement rate and high effectiveness, and it can be performed in an office setting without anaesthesia. Three months after the procedure, a confirmation test has to be conducted to assure a correct position of the micro-inserts and tubal occlusion. This test can be performed by hysterosalpingography (HSG), plain X-ray or ultrasound. Pregnancies reported after Essure sterilisation are, in a majority, related to non-adherence to the follow-up protocol or misreading of the confirmation test. A majority of the pregnancies occurred after HSGs that were determined to have been misinterpreted, including missed expulsion or perforation of the micro-insert. Other complications such as ectopic pregnancy and allergic reaction to the micro-inserts seem to have been described to be of low incidence.
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Affiliation(s)
- Sebastiaan Veersema
- Department of Obstetrics & Gynaecology, St Antonius Hospital, Nieuwegein, The Netherlands.
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27
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Bowel perforation after placement of tubal occlusion contraceptive. Obstet Gynecol 2015; 125:860-862. [PMID: 25751196 DOI: 10.1097/aog.0000000000000566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The tubal occlusion contraceptive provides a hysteroscopic technique for female sterilization. Efficacy of the tubal occlusion contraceptive relies on proper placement within the proximal aspect of the fallopian tubes. As long-term data become available, rates of complications are better defined. CASE This is a case of a patient who underwent placement of a tubal occlusion contraceptive. As a result of persistent pain and nausea, imaging was performed and malposition of the tubal occlusion contraceptive was identified. During laparoscopy, bowel perforation at the terminal ileum was diagnosed. Laparoscopic ileocecectomy was performed. CONCLUSION There should be a low threshold for evaluation of complications after tubal occlusion contraceptive placement. Although rare, bowel perforation after placement of the tubal occlusion contraceptive can occur. Laparoscopic management should be considered.
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28
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Braginsky L, George ST, Locher SR. Management of perforated essure with migration into small and large bowel mesentery. J Minim Invasive Gynecol 2014; 22:504-8. [PMID: 25460518 DOI: 10.1016/j.jmig.2014.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 11/04/2014] [Accepted: 11/06/2014] [Indexed: 11/29/2022]
Abstract
The Essure permanent birth control system (Conceptus Inc, San Carlos, CA) is currently the only Food and Drug Administration-approved hysteroscopic sterilization method and has been widely accepted as a safe and effective procedure. We present a rare case of tubal perforation, coil fragmentation, and distal migration into small and large bowel mesentery 8 days after the insertion of the Essure device. We describe the successful management of this complication using laparoscopy and intraoperative fluoroscopy. Providers using Essure must be aware of the possibility of fragmentation of the Essure coils. Intraoperative imaging, ideally fluoroscopy, should be strongly considered in the management of Essure migration to ensure localization and full retrieval of Essure material.
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Affiliation(s)
- Lena Braginsky
- Advocate Illinois Masonic Medical Center, Chicago, Illinois.
| | - Sean T George
- Advocate Illinois Masonic Medical Center, Chicago, Illinois
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29
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Ricci G, Restaino S, Di Lorenzo G, Fanfani F, Scrimin F, Mangino FP. Risk of Essure microinsert abdominal migration: case report and review of literature. Ther Clin Risk Manag 2014; 10:963-8. [PMID: 25484591 PMCID: PMC4240188 DOI: 10.2147/tcrm.s65634] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose To report a case of Essure microinsert abdominal migration and literature review. Methods A 41-year-old woman was counseled to undergo Essure sterilization. The procedure was hampered by the presence of endometrial cavity adhesions, obscuring left tubal ostium. By using microscissors the adhesions were progressively lysed. Since the procedure had become very painful, the patient required general anesthesia. Once adhesion lysis was completed, the tubal ostium was well visible. Both devices were then easily introduced into the fallopian tubes. At the end of the procedure, five coils were visible on the right side and five coils on the left side, as recommended. Results The 3-month hysterosalpingogram follow-up suspected abdominal migration of the left device. Laparoscopy confirmed the device displacement in the left lower abdominal quadrant. Both fallopian tubes and the uterus appeared normal. No signs of perforation were detected. The device was embedded into the omentum, but it was easily removed. Bilateral tubal sterilization was performed by bipolar coagulation. Conclusion There are only 13 cases, including the present, of Essure abdominal migration in the literature. In most cases, abdominal displacement of the microinsert is asymptomatic and does not induce tissue damage. However, in some cases, it may cause a severe adverse event, requiring major surgery. Therefore, removal of the migrated device should be performed as soon as possible. Moreover, during presterilization counseling, the patient should also be correctly informed about the risk of this rare but relevant complication, as well as about the surgical interventions that could be required to solve it.
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Affiliation(s)
- Giuseppe Ricci
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy ; Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Stefano Restaino
- Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Giovanni Di Lorenzo
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Francesco Fanfani
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Federica Scrimin
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Francesco P Mangino
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
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30
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Adelman MR, Dassel MW, Sharp HT. Management of Complications Encountered With Essure Hysteroscopic Sterilization: A Systematic Review. J Minim Invasive Gynecol 2014; 21:733-43. [DOI: 10.1016/j.jmig.2014.03.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 03/20/2014] [Accepted: 03/21/2014] [Indexed: 10/25/2022]
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