The Filshie clips tubal ligation procedure is a method of permanent sterilisation that has been used for many years.  If you are offered this type of contraception, it is likely that your doctor deems it an appropriate option for you. But what is it, and is it considered safe? Here, we offer some guidance on the benefits and risks of such treatment.

A Brief History of the Filshie Clip

The Filshie Clip was invented in the 1970s by Marcus Filshie, an obstetrician and gynaecologist in Nottingham. Prior to the 1980’s, the normal procedure for sterilisation was electrocautery. However, this procedure carried risks such as failure & electrical burns, with two women sadly dying following this procedure. It was this which prompted Filshie to look at other ways of achieving pain-free and permanent sterilisation.  

The clip proved revolutionary in that it could be inserted laparoscopically, and the patient could go home the same day. The intention was also that the clip could potentially be removed, and the sterilisation reversed, should the woman change her mind.

The Filshie clip itself is a small silicone-lined titanium clamp which is placed on the fallopian tube to create a blockage prevent eggs and sperm from meeting. It works by cutting off the blood supply to the portion of tube affected, causing the two ends of the tube to separate and fall apart, thus preventing the sperm and eggs meeting. When the two ends of tube separate, the clip may come loose and fall off the tube. 

The device was introduced to the European markets in 1982 and the US in 1997. The clip was considered very commercially successful and has been regarded as the definitive ‘gold standard’ of tubal ligation, used by doctors around the world.

Problems Associated with the Filshie Clip

Millions of women across the globe have had a filshie clips tubal ligation procedure, with very few suffering from any long term side effects following the procedure. However, since 1990, concerns regarding possible complications of the procedure have been steadily increasing in the US as well as across Europe.

  1. Clip Migration

Research suggest that the clip will naturally fall from the sterilised tube and migrate within the abdomen in up to 25% of women who undergo the procedure. Clip migration rarely causes any issues or symptoms due to the unreactive nature of the clip, however, evidence suggests that around 1% of women with clip migration do go on to suffer symptoms. 

Between 1990 and 2009, according to an American study, there were more than twenty cases of reported clip migration from the fallopian tubes to other parts of the body, including the bladder, abdominal wall, groin, bowel and vagina. There has even been a report of a Filshie clip being found in the urine of one woman. 

There are currently several Filshie clip migration lawsuits ongoing in the US because of failure to warn women of the potential consequences. In the UK, the Royal College of Obstetricians and Gynaecologists recommend that women should be warned before surgery. 

Symptoms from filshie clip migration can include:

  • No symptoms 
  • Painful periods
  • Severe pain
  • Abdominal pain
  • Bowel symptoms including rectal bleeding/ bloating
  • Urinary symptoms 
  • Vaginal symptoms 

For those suffering with any of the above symptoms who are found to have evidence of clip migration, clip removal can often result in an improvement in their symptoms once other causes have been considered and ruled out. 

Post Tubal Ligation Syndrome

Medical and scientific opinions are mixed when it comes to whether Post Tubal Ligation Syndrome (PTLS) is real, or whether the symptoms are due to other new or pre-existing conditions. It is important to remember that PTLS is not a well-established medical condition and there is limited research on the subject. It is also important to note that it can occur after any type of tubal sterilisation (e.g. clips/ electrocautery & ‘cut and tie’).

Possible theories for why PTLS occurs include:

  1. Changes in hormone levels following tubal sterilisation. This theory suggests that when the fallopian tubes are blocked, the ovaries produce less oestrogen and progesterone. However, studies have failed to show a significant change in blood hormone levels following tubal ligation. 
  2. Other experts believe that PTLS may be caused by the physical changes that occur to the fallopian tubes during the surgery. For example, the surgery may damage or severe the blood vessels, nerves, or tissues in the tubes. This in turn may lead to hormonal and physiological changes in the woman’s body. 
  3. Changes in the receptors within the fallopian tubes. Some believe that sterilisation disrupts receptors within the tubes that are involved in regulating the menstrual cycle.
  4. The timing of sterilisation itself may follow pregnancy or the stopping of a hormonal contraceptive. These life changes would affect the menstrual cycle regardless of sterilisation and may account for some of the symptoms some women suffer from. 

Symptoms can occur weeks to years after sterilisation. Common reported symptoms following tubal sterilisation include:

·      Hot flushes, night sweats

·      Rapid heartbeat

·      Irritability, mood swings

·      Trouble sleeping

·      Loss of libido

·      Hair loss

·      Plus, many other symptoms which could also be described as ‘generalised’.

Finding a successful treatment requires a thorough history and review of all other possible causes for their symptoms. For women with no other clear cause of their symptoms, tubal sterilisation reversal with removal of the clips (if present) can be a successful treatment option, resulting in a quick improvement in many of their symptoms.  

·      Vaginal dryness

·      Anxiety

·      Aches and pains

Conclusion

Whilst PTLS and clip migration does affect some women after tubal ligation, it is important to remember that the sterilisation procedure is generally safe and highly effective at preventing pregnancy. If you are considering tubal ligation, it is important to speak with your healthcare provider about all the potential risks and benefits, as well as all available contraceptive options.

If you are having any problems following your tubal ligation or would like to consider a reversal of your sterilisation, please contact Mr Sam Dobson’s P.A, Mandy Banbury, via our contact page or phone 0115 966 2111 to arrange an initial telephone appointment.