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Saturday, January 16, 2016

Removal of the Fallopian Tubes Endorsed as A Contraceptive Strategy

Although IUDs and long acting progesterone contraceptives have virtually the same effectiveness of tubal ligation as a strategy for contraception, sterilization is still very popular. Women had been more interested in transcervical techniques like Essure as belly incisions are not ever that popular. However the newest information is that acutally removing the fallopian tube is an effective ovarian cancer strategy and is thus gaining popularity. , not so much. Boys don't destroy that six pack to wind down the production factory, obvious anatomic differences aside, it's time women realize that they don't have to either. Soon we will have reached the first decade of the less invasive, inserted through the cervix into the fallopian tube techniques known as transcervical sterilization. The Essure device was approved in 2002. Adiana came available to American women in 2009, and has been gone since 2012, so there really is no Adiana, and much of the information in this post is left for historical interest. But we do have laparsocpic tubal ligation, something to consider if you are getting surgery for ovarian cysts, endometriosis or a tubal pregnancy, or if your plan covers them at a better financial rate. So women now have only one modern sterilization choices, the Essure. Essure device has changed slightly as they have continued to develop their system, and each device's clinical data from studies since the FDA approval. The effectiveness of Essure has been as close to perfection as us gynos get, with very few failures. Adiana's success rates had been a bit lower, still it was very close to perfection, at over 98% and the failures were due to incomplete sealing or patients relying on their device technique without proper follow up which should be a check of the fallopian tube closure with x-ray done at the three month point. Although initial follow up said that  Adiana should  98% success, there have been a few more Adiana failures, and the FDA has specifically asked them to follow their patients out for 10 years to get the proper perspective, but the company pulled the device from the market. As with any complication from a procedure, those of you who did have this treatment are urged to contact the FDA if you did have a failure. All of us are guilty of skipping to the back of the book at least once in our lives. Well, knowing those final statistics is a bit like skipping to the back of the book: the key figures you want to know when you step up to the plate, what's really your chance fore a home run? So what's the chance that your gyno will get both those little coils where they belong so that you can get those tubes plugged properly. In the early studies about 9/10 can get their devices both placed properly on the first try and in the later studies the Essure got anchored into place almost 95% , Adiana placement well into both tubes just a bit less, so for those patients with an Adiana we would want you to do a home pregnancy test if you do not get a period. Essure coils, like an IUD, can get dislodged, check some of our other posts about this. If the device is dislodged, even if the tubes look sealed on  x ray study, they should be relied upon.Essure devices can be seen easily on x ray and on ultrasound, but Adiana neither. So determining perfect placement may be a bit harder with Adiana, if we're wondering how the post operative check ups compare. Neither procedure cuts into the tummy, both Adiana and Essure were both quick and safe, but they are a bit different. The Essure can use the salt water for the visualization part through the hysteroscope during the procedure, the Adiana used slightly different solution during the procedure, not a difference you as the patient would have noted.So If you are planning sterilization today, most likely you will get an Essure, or just consider an IUD,
but some will still get a laparoscopic tubal, and others in the past were able to get an Adiana.

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