A comparison of the modified Pomeroy tubal ligation and Filshie clips for immediate postpartum sterilisation: A systematic review

Objectives The modified Pomeroy procedure is currently the most widely used method for postpartum sterilisation. Alternative options are Filshie clips, Hulka-Clemens clips and Falope rings. In this systematic review we pooled the available evidence in order to compare the failure rates, complications, technical difficulties, and reversibility of the Pomeroy method and Filshie clips when resorted to for postpartum sterilisation. Methods We gathered data from MEDLINE, EMBASE (1970-2010), the Cochrane database, and reference lists of randomised controlled trials (RCTs) and observational studies. We extracted information on study design, sample characteristics, interventions, and outcomes. Results Our search yielded 294 citations of which 43 were retrieved for detailed evaluation. Fourteen studies were included in the systematic review. One RCT and three observational studies compared failure rates of the Pomeroy method vs. Filshie clips. A random-effects analysis of the pooled studies showed no difference in the failures rates between these two methods (odds ratio 0.76 [95% confidence interval 0.30-1.95]). Complication rates were similar although the Filshie clip technique was reported to be easier. Conclusions Filshie clip application is easier to perform. The failure and complication rates are comparable to those of the modified Pomeroy method, when performed in the postpartum period.