This case report describes a failure after correct clip application at a time unrelated to pregnancy and discusses some implications of this form of sterilization. A 26-year-old patient with 3 children had a laparoscopic clip sterilization performed by a double portal approach. A good view of a normal pelvis was obtained and a clip applied to the isthmic region of each tube, approximately 2 cm from the cornu. The clips appeared to be completely across both tubes. The patient presented again 4 months later with a history of 7 weeks' amenorrhea and a positive pregnancy test. Vagainal suction termination of the pregnancy was performed and bilateral partial salpingectomy performed through a small transverse suprapubic incision. The portion of tube beneath the left clip was completely occluded on histological examination, while that on the right was obviously patent. The clips were completely across and correctly applied at right angles to the isthmic regions with no other adjacent structures included: the hinges were apparently intact and the springs were fully engaged. Most reported cases of pregnancy when clips were thought to have been correctly applied (although such application is rarely confirmed by further study) occur within 11 months of the primary procedure, suggesting failure of tubal occlusion to be the cause, rather than recanalization. It is believed that this pregnant case is the 1st reported in which failure to occlude a tube has been followed by careful assessment of the anatomical correctness of application and histological examination of the clipped portions of both tubes. The case demonstrates that even when clips are correctly applied, with careful exclusion of adjacent nontubal structures, and at a time unrelated to pregnancy, there is still no visible evidence of tubal occlusion such as that seen after ring or coagulation procedures. While it is possible that the clip mechanism itself was at fault, both clips were completely locked over their respective tubes, and one had produced absolute histological obliteration of the lumen. Failure of the clip method, however rare, may therefore be entirely unpredictable. It appears that further evaluation of clip application is indicated in view of this failure with anatomically normal, nonpregnant tubes.

作者：P E, Savage；G, Dixon

来源：Journal of obstetrics and gynaecology 1981 年 1卷 3期