Implantation Of Silastic Band On Ovary

Author Information

Valvi D*, Parulekar SV**.

(* Assistant (Professor, ** Professor and Head, Department of Obstetrics and Gynecology, Seth GS Medical College & KEM Hospital, Mumbai, India.)

Abstract

Silastic band or falope ring application is the most popular technique of laparoscopic tubal ligation in India. Once mastered, the technique is straightforward to use. However the learning curve is quite steep, and there can be a number of errors in the learning phase. Losing silastic bands in the peritoneal cavity is one such error. We present a case in which such a lost silastic band got implanted on an ovary secondarily. This is the first case of this type in the world literature.

Introduction

Falope rings are made of a combination of silicone and rubber which allows specific elasticity with a solution of 5% barium sulphate.  Barium sulphate allows identification of ring on radiologic imaging.[1] These rings has high degree of elasticity and 97 to 100% memory.  These are biocompatible and bio durable. They do not cause foreign body reaction or infection. As the falope ring contracts due to its elasticity, it constricts the base of the loop and blocks the fallopian tube. Deprived of its blood supply, the constricted loop is resorbed. With use of falope ring risk of complication and the subsequent pregnancies are lowest and benefit is greatest.  Full visualization of fallopian tubes and proper instrumentation eliminate the risk of misapplication of rings to the ligaments or bowel.

Case Report

A 48years old woman Para 1 living 1 abortion1 presented with abnormal uterine bleeding which was found to be due to uterine leimyomas enlarging the uterus to 18 weeks’ size. She had undergone laparoscopic tubal ligation 15 years back. Records and details of tubal ligation were not available. An abdominal hysterectomy was performed on her after ultrasonography for confirmation of the diagnosis and investigations for fitness for anesthesia. During hysterectomy it was found that one falope ring was adherent to the left ovary (figures 1 and 2). Tubal ligation sites were normal and falope rings were seen at the tubal ligation site, one on each fallopian tube. There were no falope rings lying free in the peritoneal cavity.

Figure 1. Falope ring adherent to the surface of the left ovary.

Figure 2. Falope ring adherent to the surface of the left ovary, another view.

Discussion

Laparoscopic female sterilization with falope rings is a minor procedure. However it is not simple and the learning curve is quite steep. The operator must be skilled and well acquainted with the instruments and every part of the procedure of laparoscopic sterilization using falope rings. Complication like misapplication of ring to uteroovarian or round ligament, or mesosalpinx can occur, leading to failure of the sterilization procedure and a pregnancy. If it is applied to the bowel, there is risk of perforative peritonitis. Nonapplication of rings is seen when the operating surgeon is inexperienced or during learning period. Loss of rings in the peritoneal cavity can also occur during procedure.[2] Severe inflammatory reaction and peritonitis are noted following falope ring tubal ligation reported in the review of literature.[3] Postoperative salphingitis causing detachment of falope ring also reported in review of literature.[4] In our case a falope ring was adherent to the left ovary. It could not have been primarily applied to the ovary, because the firm and smooth tissue of the ovary cannot be drawn into the falope ring applicator by the prongs of the applicator. Any such effort would result in the prongs cutting through the ovary during application of ring. Falope rings are inert, biocompatible and bio durable and do not cause foreign body reaction. Hence they do not get adherent to any structure in the body.  Adherence of the falope ring to the ovary may be explained by positioning of a free lying intraperitoneal ring over the stigma of an ovarian follicle after ovulation, and its entanglement in subsequent healing process. Another explanation is that pelvic inflammation and subsequent fibrosis could have trapped a free lying intraperitoneal ring over the surface of the ovary. In our case there was no evidence of past pelvic infection and fibrosis. So the former explanation seems to be the most likely cause of the falope ring getting adherent to the ovary.

Though free lying falope rings are not reported to cause any complications, they indicate lack of expertise in performing the procedure, and that in the evnt of failure of sterilization, may contribute to evidence of negligence. Our case report helps to draw attention to occurrence of loss of falope rings in the peritoneal cavity and its implications.

References

1. Laparoscopic sterilization: prevention of failure; Schmidt, E, Diedrich, J. Glob libr women's med 2014; DOI 10.3843/GLOWM.10402\
2. Phipps JH, Drife JO. Postoperative salphingitis causing detachment of a falope ring; Journal of Obstetrics and Gynecology 1988:l8(4),367.
3. Aubert JM, Garcia A. Improving falope-ring application in laparoscopy training. J  Reprod Med 1987 May: 32(5):340-2.
4. Severe pelvic inflammatory disease and peritonitis following falope ring tubal ligation; LoBue C., J Reprod Med1981;26(11):581-4.

Citation

Valvi D, Parulekar SV. Implantation Of Silastic Band On Ovary. JPGO 2016. Volume 3 No. 9. Available from: http://www.jpgo.org/2016/09/implantation-of-silastic-band-on-ovary.html