[Report of 2180 laparoscopic tubal ligations with the Yoon ring]

Records of 2180 tubal sterilizations carried out using the Yoon procedure between March 1978-March 1980 in a pilot family planning clinic in Tunis, Tunisia, were examined to assess the medical, social, and psychosexual impact of the operation. Patients were seen by a social worker who obtained the couple's consent and evaluated their socioeconomic status, a midwife who took a careful medical and fertility history, and a medical specialist who ruled out pregnancy and contraindications. 2 of the 2180 women were unmarried. The average age was 34.6 years. No previous contraception had been used in 1300 cases, the pill had been used in 294, IUD in 593, and other methods in 45. 84 women had 0-3 living children, 1350 had 4-6, 682 had 7-9, and 60 had over 9. 1100 women had no induced abortions before the sterilization, 741 had 1, 197 had 2, 86 had 3, 30 had 4, and 26 had 5. Laparoscopy revealed 36 cases of pelvic infection, 29 of ovarian cysts, 14 of fibromas, 5 of varicoceles, 3 of endometriosis, 1 of G.E.U., 1 of developing mass, 1 of a mesosalpingeal granulation, and 1 of a Lippes loop. Most perioperative complications were associated with inexperienced operators; among them, 2 hematomas required laparotomy. There were 20 cases of uterine perforation. 8 cases of minor injury to abdominopelvic organs occurred but none required laparotomy. In 9 cases there was difficulty in creating the pneumoperitoneum, in 70 cases there was poor insertion of the ring, and in 7 cases there were errors in insertion of the ring. In 52 cases there were minor complications in the 1st postoperative week. 15.62% of the women later complained of pain related to the procedure, 9.71% of menstrual difficulties, .09% of fridigity, and .22% of dyspareunia. 2.17% complained of behavioral problems including anorexia, headaches, trembling and backaches, and frank psychic manifestations. 5 cases of poststerilization pregnancy were discovered, a failure rate of .08%.