[Reproduction: control: the surgical methods]

Surgical methods indicated for controlling fertility are briefly outlined and reviewed. The various sterilization procedures described are said to result in unwanted pregnancy rates which vary from 0-5% depending on the experience of the surgeon and the procedure used. The vaginal method of female sterilization seems to carry a slightly higher failure rate than the recommended abdominal approaches; but even a subtotal hysterectomy has been followed by pregnancy. Nevertheless surgical control of fertility is the most dependable form. Indications for surgical sterilization in both men and women include any time a further pregnancy would risk the mothers health or when there is an unacceptable risk of delivering a damaged child. The preparation of the patient in both its practical and ethical senses is emphasized and the physicians role in clearly delineating the surgerys outcome must be strong. Techniques of male sterilization all include interruption of the vas deferens and common complications of vas ligation or occlusion procedures are infection of the operative site epididymitis-orchitis hematoma formation and damage to the testicular artery. 10% of reversals of vas interruption operations may be successful. For female sterilization vaginal and abdominal approaches are described along with use of laparoscopy (coagulation of tubes; excision is not recommended) and hysterectomy. Women require general anesthesia for their surgical interventions whereas male sterilization can be accomplished under local anesthesia. Complications are greater in vaginal approach surgery because of the exposure to intraabdominal hemorrhage and postoperative abscess. This review advocates using the abdominal approach for female sterilization.