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Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
Figure 1

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Comparison 1 Tubal ring versus clip, Outcome 1 Major morbidity: total.
Figuras y tablas -
Analysis 1.1

Comparison 1 Tubal ring versus clip, Outcome 1 Major morbidity: total.

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Comparison 1 Tubal ring versus clip, Outcome 2 Minor morbidity: total.
Figuras y tablas -
Analysis 1.2

Comparison 1 Tubal ring versus clip, Outcome 2 Minor morbidity: total.

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Comparison 1 Tubal ring versus clip, Outcome 3 Minor morbidity: details.
Figuras y tablas -
Analysis 1.3

Comparison 1 Tubal ring versus clip, Outcome 3 Minor morbidity: details.

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Comparison 1 Tubal ring versus clip, Outcome 4 Technical failures.
Figuras y tablas -
Analysis 1.4

Comparison 1 Tubal ring versus clip, Outcome 4 Technical failures.

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Comparison 1 Tubal ring versus clip, Outcome 5 Technical difficulties.
Figuras y tablas -
Analysis 1.5

Comparison 1 Tubal ring versus clip, Outcome 5 Technical difficulties.

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Comparison 1 Tubal ring versus clip, Outcome 6 Failure rate: total.
Figuras y tablas -
Analysis 1.6

Comparison 1 Tubal ring versus clip, Outcome 6 Failure rate: total.

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Comparison 1 Tubal ring versus clip, Outcome 7 Failure rate: details.
Figuras y tablas -
Analysis 1.7

Comparison 1 Tubal ring versus clip, Outcome 7 Failure rate: details.

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Comparison 1 Tubal ring versus clip, Outcome 8 Operative time.
Figuras y tablas -
Analysis 1.8

Comparison 1 Tubal ring versus clip, Outcome 8 Operative time.

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Comparison 1 Tubal ring versus clip, Outcome 9 Hospital stay > 24 h.
Figuras y tablas -
Analysis 1.9

Comparison 1 Tubal ring versus clip, Outcome 9 Hospital stay > 24 h.

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Comparison 1 Tubal ring versus clip, Outcome 10 Complaints.
Figuras y tablas -
Analysis 1.10

Comparison 1 Tubal ring versus clip, Outcome 10 Complaints.

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Comparison 1 Tubal ring versus clip, Outcome 11 Menstrual irregularities.
Figuras y tablas -
Analysis 1.11

Comparison 1 Tubal ring versus clip, Outcome 11 Menstrual irregularities.

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Comparison 2 Partial salpingectomy (modified Pomeroy) versus electrocoagulation, Outcome 1 Operative mortality.
Figuras y tablas -
Analysis 2.1

Comparison 2 Partial salpingectomy (modified Pomeroy) versus electrocoagulation, Outcome 1 Operative mortality.

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Comparison 2 Partial salpingectomy (modified Pomeroy) versus electrocoagulation, Outcome 2 Major morbidity: total.
Figuras y tablas -
Analysis 2.2

Comparison 2 Partial salpingectomy (modified Pomeroy) versus electrocoagulation, Outcome 2 Major morbidity: total.

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Comparison 2 Partial salpingectomy (modified Pomeroy) versus electrocoagulation, Outcome 3 Major morbidity: details.
Figuras y tablas -
Analysis 2.3

Comparison 2 Partial salpingectomy (modified Pomeroy) versus electrocoagulation, Outcome 3 Major morbidity: details.

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Comparison 2 Partial salpingectomy (modified Pomeroy) versus electrocoagulation, Outcome 4 Minor morbidity: total.
Figuras y tablas -
Analysis 2.4

Comparison 2 Partial salpingectomy (modified Pomeroy) versus electrocoagulation, Outcome 4 Minor morbidity: total.

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Comparison 2 Partial salpingectomy (modified Pomeroy) versus electrocoagulation, Outcome 5 Minor morbidity: details.
Figuras y tablas -
Analysis 2.5

Comparison 2 Partial salpingectomy (modified Pomeroy) versus electrocoagulation, Outcome 5 Minor morbidity: details.

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Comparison 2 Partial salpingectomy (modified Pomeroy) versus electrocoagulation, Outcome 6 Failure rate: total.
Figuras y tablas -
Analysis 2.6

Comparison 2 Partial salpingectomy (modified Pomeroy) versus electrocoagulation, Outcome 6 Failure rate: total.

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Comparison 2 Partial salpingectomy (modified Pomeroy) versus electrocoagulation, Outcome 7 Failure rate: details.
Figuras y tablas -
Analysis 2.7

Comparison 2 Partial salpingectomy (modified Pomeroy) versus electrocoagulation, Outcome 7 Failure rate: details.

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Comparison 2 Partial salpingectomy (modified Pomeroy) versus electrocoagulation, Outcome 8 Hospital stay more 24 h.
Figuras y tablas -
Analysis 2.8

Comparison 2 Partial salpingectomy (modified Pomeroy) versus electrocoagulation, Outcome 8 Hospital stay more 24 h.

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Comparison 2 Partial salpingectomy (modified Pomeroy) versus electrocoagulation, Outcome 9 Complaints.
Figuras y tablas -
Analysis 2.9

Comparison 2 Partial salpingectomy (modified Pomeroy) versus electrocoagulation, Outcome 9 Complaints.

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Comparison 3 Tubal ring versus electrocoagulation, Outcome 1 Major morbidity: total.
Figuras y tablas -
Analysis 3.1

Comparison 3 Tubal ring versus electrocoagulation, Outcome 1 Major morbidity: total.

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Comparison 3 Tubal ring versus electrocoagulation, Outcome 2 Major morbidity: details.
Figuras y tablas -
Analysis 3.2

Comparison 3 Tubal ring versus electrocoagulation, Outcome 2 Major morbidity: details.

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Comparison 3 Tubal ring versus electrocoagulation, Outcome 3 Minor morbidity: total.
Figuras y tablas -
Analysis 3.3

Comparison 3 Tubal ring versus electrocoagulation, Outcome 3 Minor morbidity: total.

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Comparison 3 Tubal ring versus electrocoagulation, Outcome 4 Minor morbidity: details.
Figuras y tablas -
Analysis 3.4

Comparison 3 Tubal ring versus electrocoagulation, Outcome 4 Minor morbidity: details.

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Comparison 3 Tubal ring versus electrocoagulation, Outcome 5 Technical failures: total.
Figuras y tablas -
Analysis 3.5

Comparison 3 Tubal ring versus electrocoagulation, Outcome 5 Technical failures: total.

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Comparison 3 Tubal ring versus electrocoagulation, Outcome 6 Technical difficulties.
Figuras y tablas -
Analysis 3.6

Comparison 3 Tubal ring versus electrocoagulation, Outcome 6 Technical difficulties.

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Comparison 3 Tubal ring versus electrocoagulation, Outcome 7 Failure rate: total.
Figuras y tablas -
Analysis 3.7

Comparison 3 Tubal ring versus electrocoagulation, Outcome 7 Failure rate: total.

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Comparison 3 Tubal ring versus electrocoagulation, Outcome 8 Operative time.
Figuras y tablas -
Analysis 3.8

Comparison 3 Tubal ring versus electrocoagulation, Outcome 8 Operative time.

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Comparison 3 Tubal ring versus electrocoagulation, Outcome 9 Complaints.
Figuras y tablas -
Analysis 3.9

Comparison 3 Tubal ring versus electrocoagulation, Outcome 9 Complaints.

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Comparison 3 Tubal ring versus electrocoagulation, Outcome 10 Menstrual irregularities.
Figuras y tablas -
Analysis 3.10

Comparison 3 Tubal ring versus electrocoagulation, Outcome 10 Menstrual irregularities.

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Comparison 4 Partial salpingectomy (PS) versus clip, Outcome 1 Operative mortality.
Figuras y tablas -
Analysis 4.1

Comparison 4 Partial salpingectomy (PS) versus clip, Outcome 1 Operative mortality.

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Comparison 4 Partial salpingectomy (PS) versus clip, Outcome 2 Major morbidity: total.
Figuras y tablas -
Analysis 4.2

Comparison 4 Partial salpingectomy (PS) versus clip, Outcome 2 Major morbidity: total.

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Comparison 4 Partial salpingectomy (PS) versus clip, Outcome 3 Minor morbidity: total.
Figuras y tablas -
Analysis 4.3

Comparison 4 Partial salpingectomy (PS) versus clip, Outcome 3 Minor morbidity: total.

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Comparison 4 Partial salpingectomy (PS) versus clip, Outcome 4 Minor morbidity: details.
Figuras y tablas -
Analysis 4.4

Comparison 4 Partial salpingectomy (PS) versus clip, Outcome 4 Minor morbidity: details.

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Comparison 4 Partial salpingectomy (PS) versus clip, Outcome 5 Technical failures.
Figuras y tablas -
Analysis 4.5

Comparison 4 Partial salpingectomy (PS) versus clip, Outcome 5 Technical failures.

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Comparison 4 Partial salpingectomy (PS) versus clip, Outcome 6 Technical difficulties.
Figuras y tablas -
Analysis 4.6

Comparison 4 Partial salpingectomy (PS) versus clip, Outcome 6 Technical difficulties.

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Comparison 4 Partial salpingectomy (PS) versus clip, Outcome 7 Failure rate (12 months) : total.
Figuras y tablas -
Analysis 4.7

Comparison 4 Partial salpingectomy (PS) versus clip, Outcome 7 Failure rate (12 months) : total.

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Comparison 4 Partial salpingectomy (PS) versus clip, Outcome 8 Operative time.
Figuras y tablas -
Analysis 4.8

Comparison 4 Partial salpingectomy (PS) versus clip, Outcome 8 Operative time.

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Comparison 4 Partial salpingectomy (PS) versus clip, Outcome 9 All complaints.
Figuras y tablas -
Analysis 4.9

Comparison 4 Partial salpingectomy (PS) versus clip, Outcome 9 All complaints.

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Comparison 4 Partial salpingectomy (PS) versus clip, Outcome 10 Menstrual irregularities.
Figuras y tablas -
Analysis 4.10

Comparison 4 Partial salpingectomy (PS) versus clip, Outcome 10 Menstrual irregularities.

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Comparison 4 Partial salpingectomy (PS) versus clip, Outcome 11 Women's satisfaction.
Figuras y tablas -
Analysis 4.11

Comparison 4 Partial salpingectomy (PS) versus clip, Outcome 11 Women's satisfaction.

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Study

.

.

Kohaut 2004

Seven out of 10 surgeons performing a total of 29 sterilisations preferred the Filshie clip method to the Pomeroy method.

Figuras y tablas -
Analysis 4.12

Comparison 4 Partial salpingectomy (PS) versus clip, Outcome 12 Surgeon's satisfaction.

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Comparison 5 Hulka versus Filshie clip, Outcome 1 Minor morbidity: total.
Figuras y tablas -
Analysis 5.1

Comparison 5 Hulka versus Filshie clip, Outcome 1 Minor morbidity: total.

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Comparison 5 Hulka versus Filshie clip, Outcome 2 Minor morbidity: details.
Figuras y tablas -
Analysis 5.2

Comparison 5 Hulka versus Filshie clip, Outcome 2 Minor morbidity: details.

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Comparison 5 Hulka versus Filshie clip, Outcome 3 Technical failures.
Figuras y tablas -
Analysis 5.3

Comparison 5 Hulka versus Filshie clip, Outcome 3 Technical failures.

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Comparison 5 Hulka versus Filshie clip, Outcome 4 Technical difficulties.
Figuras y tablas -
Analysis 5.4

Comparison 5 Hulka versus Filshie clip, Outcome 4 Technical difficulties.

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Comparison 5 Hulka versus Filshie clip, Outcome 5 Failure rate: total.
Figuras y tablas -
Analysis 5.5

Comparison 5 Hulka versus Filshie clip, Outcome 5 Failure rate: total.

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Comparison 5 Hulka versus Filshie clip, Outcome 6 Operative time.
Figuras y tablas -
Analysis 5.6

Comparison 5 Hulka versus Filshie clip, Outcome 6 Operative time.

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Comparison 5 Hulka versus Filshie clip, Outcome 7 Complaints.
Figuras y tablas -
Analysis 5.7

Comparison 5 Hulka versus Filshie clip, Outcome 7 Complaints.

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Summary of findings for the main comparison. Summary of findings: ring versus clip

Tubal ring compared with tubal clip for interval sterilisation

Patient or population: women > 6 weeks postpartum requesting tubal sterilisation

Settings: any

Intervention: tubal ring

Comparison: tubal clip

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Clip

Ring

Major morbidity: total

Low risk population

OR 0.14

(0.00 to 7.05)

545

(1)

⊕⊕⊝⊝
low1,2

Only one event occurred in the clip group

4 per 1000

1 per 1000

(0 to 28)

Minor morbidity: total

Low risk population

OR 2.15

(1.22 to 3.78)

842
(2)

⊕⊕⊕⊕
high

57 per 1000

123 per 1000
(70 to 215)

Minor morbidity: details ‐ procedure‐related injuries

Low risk population

OR 1.95

(1.36 to 2.78)

3575
(3)

⊕⊕⊕⊕
high

21 per 1000

41 per 1000
(29 to 58)

Technical failures

Low risk population

OR 3.93

(2.43 to 6.35)

3476

(3)

⊕⊕⊕⊕
high

10 per 1000

39 per 1000
(24 to 63)

Failure rate: details

(12 to 24 months)

Low risk population

OR 0.72

(0.33 to 1.57)

3822
(4)

⊕⊕⊕⊕
high

4 per 1000

3 per 1000
(1 to 6)

Complaints: Postoperative pain

(24 hours)

Low risk population

OR 1.14

(0.88 to 1.48)

922

(3)

⊕⊕⊕⊕
high

477 per 1000

544 per 1000
(420 to 706)

*The basis for the assumed risk is the median control group (clip) risk across studies. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; OR: odds ratio

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 Downgraded due to imprecision.

2 Downgraded due to sparse data.

Figuras y tablas -
Summary of findings for the main comparison. Summary of findings: ring versus clip
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Summary of findings 2. Summary of findings: modified Pomeroy partial salpingectomy versus electrocoagulation

Modified Pomeroy partial salpingectomy compared with tubal electrocoagulation for interval sterilisation

Patient or population: women > 6 weeks postpartum requesting tubal sterilisation

Settings: any

Intervention: modified Pomeroy partial salpingectomy

Comparison: electrocoagulation

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Electrocoagulation

Modified Pomeroy

Major morbidity: total

Low risk population

OR 2.87

(1.13 to 7.25)

1905

(2)

⊕⊕⊝⊝
low1,2

10 per 1000

29 per 1000
(11 to 73)

Major morbidity: procedure‐related injuries requiring additional operation or blood transfusion

10 per 1000

19 per 1000

(19 to 190)

OR 1.90

(0.19 to 18.96)

1905

(2)

⊕⊕⊝⊝
low 1,2

Major morbidity: rehospitalisation as a consequence of the operation

20 per 1000

115 per 1000

(15 to 900)

OR 5.74

(0.73 to 45.09)

295

(1)

⊕⊝⊝⊝
very low1,2

Minor morbidity: total

Low risk population

OR 1.60

(1.10 to 2.33)

1905

(2)

⊕⊕⊝⊝
low 1,4

The WHO study reported significantly more wound infections in the modified Pomeroy group, where participants underwent minilaparotomy, compared with the electrocoagulation group where laparoscopy was used)

38 per 1000

61 per 1000
(42 to 89)

Minor morbidity: procedure‐related injuries with no additional operation

Low risk population

OR 0.53

(0.06 to 5.11)

1610
(1)

⊕⊕⊕⊝
moderate1

2 per 1000

1 per 1000
0 to 10)

Failure rate: total

(12 months)

Low risk population

OR 4.47 (0.07 to 286.78)

295

(1)

⊕⊕⊝⊝
low1,3

0.5 per 1000

2 per 1000

(0 to 143)

Complaints ‐ postoperative pain

(24 hours)

Low risk population

OR 3.85

(2.91 to 5.10)

1905

(2)

⊕⊕⊕⊝
moderate4

95 per 1000

366 per 1000
(276 to 485)

Complaints ‐ persistent pain at follow‐up visit

Low risk population

OR 1.09

(0.88 to 1.47)

1610
(1)

⊕⊕⊕⊝
moderate4

117 per 1000

128 per 1000
(95 to 172)

*The basis for the assumed risk is the median control group (electrocoagulation) risk across studies. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; OR: odds ratio

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 Downgraded due to imprecision.

2 Downgraded due to inconsistency.

3 Sparse data.

4 Downgraded due to indirectness (this effect may be due to the abdominal approach (minilaparotomy versus laparoscopy) rather than the tubal technique).

Figuras y tablas -
Summary of findings 2. Summary of findings: modified Pomeroy partial salpingectomy versus electrocoagulation
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Summary of findings 3. Summary of findings: tubal ring versus electrocoagulation

Tubal ring compared with electrocoagulation for interval sterilisation

Patient or population: women > 6 weeks postpartum requesting tubal sterilisation

Settings: any

Intervention: tubal ring

Comparison: electrocoagulation

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Electrocoagulation

Ring

Major morbidity: total

Low risk population

OR 0.14

0.00 to 7.01

596
(2)

⊕⊕⊝⊝

low1,2

Unipolar electrocoagulation stated in one study and not specified in the other. Only one event reported in total

0.5 per 1000

0 per 1000

(0 to 4)

Minor morbidity: total

Low risk population

OR 0.97

(0.50, 1.87)

596
(2)

⊕⊕⊕⊝
moderate1

66 per 1000

64 per 1000
(33 to 123)

Technical failures: total

Low risk population

OR 3.42

(0.59 to 19.81)

596
(2)

⊕⊕⊕⊝
moderate1

3 per 1000

10 per 1000
(2 to 60)

Failure rate: total

not estimable

not estimable

Not estimable due to insufficient data

160
(1)

‐

No pregnancies reported in one study

Complaints ‐ postoperative pain

(24 hours)

Low risk population

OR 3.40

(1.17 to 9.84)

596
(2)

⊕⊕⊝⊝

low1,3

176 per 1000

598 per 1000
(206 to 1000)

Complaints ‐ persistent pain at follow‐up visit

Low risk population

OR 1.22

(0.75 to 1.97)

594
(2)

⊕⊕⊕⊝
moderate1

140 per 1000

171 per 1000
(105 to 276)

*The basis for the assumed risk is the median control group (electrocoagulation) risk across studies. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; OR: odds ratio

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 Downgraded due to imprecision.

2 Downgraded due to sparse data.

3 Downgraded due to inconsistency.

Figuras y tablas -
Summary of findings 3. Summary of findings: tubal ring versus electrocoagulation
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Summary of findings 4. Summary of findings: partial salpingectomy versus clip

Partial salpingectomy compared with tubal clips for tubal sterilisation

Patient or population: women requesting postpartum or interval sterilisation

Settings: any

Intervention: partial salpingectomy

Comparison: tubal clips

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Clips

Partial salpingectomy

Major morbidity: total

Low risk population

not estimable

2198
(1)

‐

No deaths or major morbidity events reported in one large trial

0 per 1000

0 per 1000

Minor morbidity: total

Low risk population

OR 7.39

(0.46 to 119.01)

193
(1)

⊕⊕⊝⊝
low1,2

0.5 per 1000

4 per 1000
(0 to 60)

Technical failures

Low risk population

OR 0.18

(0.08 to 0.40)

2198
(1)

⊕⊕⊕⊝
moderate3

20 per 1000

4 per 1000
(2 to 8)

Failure rate: total

(12 months)

Low risk population

OR 0.21, 95% CI 0.05 to 0.84

3537
(2)

⊕⊕⊕⊝
moderate 4

In this analysis, we grouped studies according to whether sterilisation was performed on a postpartum (1) or interval basis (1). Results were similar across these subgroups (Test for subgroup differences: P value 0.58, I² = 0%)

2 per 1000

0.4 per 1000
(0 to 2)

Complaints

(12 months)

Low risk population

OR 1.30 (0.92 to 1.82)

2137

(1)

⊕⊕⊕⊝
moderate1

This single study reported data on 'chief complaints' at 3, 6, and 12 months and rates were similar between groups at all assessment points

59 per 1000

77 per 1000

(54 to 107)

*The basis for the assumed risk is the median control group (clips) risk across studies. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; OR: odds ratio

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 Downgraded due to imprecision.

2 Downgraded due to sparse data.

3 Downgraded due to indirectness (unclear whether silver clips and Filshie clips are similarly effective).

4 Downgraded due to risk of bias.

Figuras y tablas -
Summary of findings 4. Summary of findings: partial salpingectomy versus clip
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Summary of findings 5. Summary of findings: Hulka clip versus Filshie clip

Hulka clips compared with Filshie clips for interval sterilisation

Patient or population: women requesting sterilisation

Settings: any

Intervention: Hulka clips

Comparison: Filshie clips

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Filshie clip

Hulka clip

Minor morbidity: total

Low risk population

OR 0.14

(0.00 to 7.32)

197
(1)

⊕⊕⊝⊝
low1,2

10 per 1000

1 per 1000
(0 to 70)

Minor morbidity: procedure‐related injuries

Low risk population

OR 1.55

(0.73 to 3.26)

2322
(2)

⊕⊕⊕⊝
moderate1

10 per 1000

16 per 1000
(7 to 33)

Technical failures

Low risk population

OR 1.04

(0.10 to 11.33)

2325

(2)

⊕⊕⊝⊝
low1,3

7 per 1000

7 per 1000

(1 to 79)

Failure rate: total

(12 months)

Low risk population

OR 6.20

(0.75 to 51.66)

1441

(1)

⊕⊕⊕⊝
moderate1

1 per 1000

6 per 1000

(1 to 52)

Complaints: postoperative pain

(24 hours)

Low risk population

OR 1.74

(0.99 to 3.03)

197
(1)

⊕⊕⊝⊝
low1,4

45 per 1000

78 per 1000
(45 to 136)

*The basis for the assumed risk is the median control group (Filshie clips) risk across studies. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; OR: odds ratio

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 Downgraded due to imprecision.

2 Downgraded due to sparse data.

3Downgraded due to inconsistency.

4 Downgraded due to risk of bias.

Figuras y tablas -
Summary of findings 5. Summary of findings: Hulka clip versus Filshie clip
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Comparison 1. Tubal ring versus clip

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Major morbidity: total Show forest plot

1

Peto Odds Ratio (Peto, Fixed, 95% CI)

Subtotals only

1.1 Procedure‐related injuries requiring additional operation or blood transfusion

1

545

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.14 [0.00, 7.05]

2 Minor morbidity: total Show forest plot

2

842

Peto Odds Ratio (Peto, Fixed, 95% CI)

2.15 [1.22, 3.78]

3 Minor morbidity: details Show forest plot

3

Peto Odds Ratio (Peto, Fixed, 95% CI)

Subtotals only

3.1 Procedure related injuries with no additional operation

3

3575

Peto Odds Ratio (Peto, Fixed, 95% CI)

1.95 [1.36, 2.78]

3.2 Urogenital infections

3

3145

Peto Odds Ratio (Peto, Fixed, 95% CI)

1.88 [0.83, 4.28]

3.3 Wound infection

3

3144

Peto Odds Ratio (Peto, Fixed, 95% CI)

1.17 [0.73, 1.87]

3.4 Postoperative temperature > 38 °C without hospitalisation

1

296

Peto Odds Ratio (Peto, Fixed, 95% CI)

7.49 [0.15, 377.52]

4 Technical failures Show forest plot

3

3476

Peto Odds Ratio (Peto, Fixed, 95% CI)

3.93 [2.43, 6.35]

5 Technical difficulties Show forest plot

3

3590

Peto Odds Ratio (Peto, Fixed, 95% CI)

1.13 [0.87, 1.46]

6 Failure rate: total Show forest plot

4

3822

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.72 [0.33, 1.57]

7 Failure rate: details Show forest plot

2

Peto Odds Ratio (Peto, Fixed, 95% CI)

Subtotals only

7.1 Failure rate ≤ 1 year, total

2

2629

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.85 [0.23, 3.14]

7.2 Failure rate ≤ 1 year, extrauterine pregnancy

1

2202

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.0 [0.0, 0.0]

7.3 Failure rate > 1 year, extrauterine pregnancy

1

427

Peto Odds Ratio (Peto, Fixed, 95% CI)

8.11 [0.16, 410.33]

8 Operative time Show forest plot

1

297

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

9 Hospital stay > 24 h Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Totals not selected

10 Complaints Show forest plot

4

Peto Odds Ratio (Peto, Fixed, 95% CI)

Subtotals only

10.1 Postoperative pain < 24 h

3

922

Peto Odds Ratio (Peto, Fixed, 95% CI)

1.14 [0.88, 1.48]

10.2 Postoperative analgesic use

1

70

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.70 [0.28, 1.79]

10.3 Cramping pain during first week after surgery

1

70

Peto Odds Ratio (Peto, Fixed, 95% CI)

5.24 [1.52, 18.00]

11 Menstrual irregularities Show forest plot

2

612

Peto Odds Ratio (Peto, Fixed, 95% CI)

1.61 [0.75, 3.49]
Figuras y tablas -
Comparison 1. Tubal ring versus clip
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Comparison 2. Partial salpingectomy (modified Pomeroy) versus electrocoagulation

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Operative mortality Show forest plot

1

1610

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Major morbidity: total Show forest plot

2

1905

Peto Odds Ratio (Peto, Fixed, 95% CI)

2.87 [1.13, 7.25]

3 Major morbidity: details Show forest plot

2

Odds Ratio (M‐H, Random, 95% CI)

Subtotals only

3.1 Procedure‐related injuries requiring additional operation or blood transfusion

2

1905

Odds Ratio (M‐H, Random, 95% CI)

1.90 [0.19, 18.96]

3.2 Rehospitalisation as a consequence of operation

1

295

Odds Ratio (M‐H, Random, 95% CI)

5.74 [0.73, 45.09]

4 Minor morbidity: total Show forest plot

2

1905

Peto Odds Ratio (Peto, Fixed, 95% CI)

1.60 [1.10, 2.33]

5 Minor morbidity: details Show forest plot

2

Peto Odds Ratio (Peto, Fixed, 95% CI)

Subtotals only

5.1 Procedure‐related injuries with no additional operation

1

1610

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.53 [0.06, 5.11]

5.2 Urogenital infections

1

1610

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.81 [0.43, 1.50]

5.3 Wound infection

1

1610

Peto Odds Ratio (Peto, Fixed, 95% CI)

2.49 [1.54, 4.04]

5.4 Postoperative temperature > 38 °C without hospitalisation

1

295

Peto Odds Ratio (Peto, Fixed, 95% CI)

1.45 [0.18, 11.77]

6 Failure rate: total Show forest plot

1

295

Peto Odds Ratio (Peto, Fixed, 95% CI)

4.47 [0.07, 286.78]

6.1 Failure rate, total

1

295

Peto Odds Ratio (Peto, Fixed, 95% CI)

4.47 [0.07, 286.78]

7 Failure rate: details Show forest plot

1

295

Peto Odds Ratio (Peto, Fixed, 95% CI)

4.47 [0.07, 286.78]

7.1 Failure rate > 1 year, total

1

295

Peto Odds Ratio (Peto, Fixed, 95% CI)

4.47 [0.07, 286.78]

8 Hospital stay more 24 h Show forest plot

1

108

Odds Ratio (M‐H, Fixed, 95% CI)

0.48 [0.08, 2.74]

9 Complaints Show forest plot

3

Peto Odds Ratio (Peto, Fixed, 95% CI)

Subtotals only

9.1 Postoperative pain < 24 h

2

1905

Peto Odds Ratio (Peto, Fixed, 95% CI)

3.85 [2.91, 5.10]

9.2 Postoperative analgesic use

1

109

Peto Odds Ratio (Peto, Fixed, 95% CI)

2.05 [0.40, 10.56]

9.3 Persistent pain at follow‐up visit

1

1610

Peto Odds Ratio (Peto, Fixed, 95% CI)

1.09 [0.81, 1.47]
Figuras y tablas -
Comparison 2. Partial salpingectomy (modified Pomeroy) versus electrocoagulation
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Comparison 3. Tubal ring versus electrocoagulation

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Major morbidity: total Show forest plot

2

596

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.14 [0.00, 7.01]

2 Major morbidity: details Show forest plot

1

298

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.14 [0.00, 7.01]

2.1 Procedure‐related injuries requiring additional operation or blood transfusion

1

298

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.14 [0.00, 7.01]

3 Minor morbidity: total Show forest plot

2

596

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.97 [0.50, 1.87]

4 Minor morbidity: details Show forest plot

2

Peto Odds Ratio (Peto, Fixed, 95% CI)

Subtotals only

4.1 Procedure‐related injuries with no additional operation

2

596

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.76 [0.17, 3.38]

4.2 Urogenital infections

1

296

Peto Odds Ratio (Peto, Fixed, 95% CI)

1.03 [0.14, 7.37]

4.3 Wound infection

1

296

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.93 [0.38, 2.25]

4.4 Postoperative temperature > 38 °C without hospitalisation

2

594

Peto Odds Ratio (Peto, Fixed, 95% CI)

1.37 [0.31, 6.06]

5 Technical failures: total Show forest plot

2

596

Peto Odds Ratio (Peto, Fixed, 95% CI)

3.42 [0.59, 19.81]

6 Technical difficulties Show forest plot

1

298

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.14 [0.01, 1.33]

7 Failure rate: total Show forest plot

1

160

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.0 [0.0, 0.0]

7.1 Failure rate, total

1

160

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.0 [0.0, 0.0]

8 Operative time Show forest plot

1

298

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

9 Complaints Show forest plot

2

Odds Ratio (M‐H, Random, 95% CI)

Subtotals only

9.1 Postoperative pain < 24 h

2

596

Odds Ratio (M‐H, Random, 95% CI)

3.40 [1.17, 9.84]

9.2 Postoperative analgesic use

1

298

Odds Ratio (M‐H, Random, 95% CI)

2.51 [1.00, 6.30]

9.3 Persistent pain at follow‐up visit

2

594

Odds Ratio (M‐H, Random, 95% CI)

1.22 [0.75, 1.97]

10 Menstrual irregularities Show forest plot

1

296

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.90 [0.56, 1.45]
Figuras y tablas -
Comparison 3. Tubal ring versus electrocoagulation
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Comparison 4. Partial salpingectomy (PS) versus clip

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Operative mortality Show forest plot

1

Peto Odds Ratio (Peto, Fixed, 95% CI)

Subtotals only

1.1 Uchida vs silver clip

1

2198

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Major morbidity: total Show forest plot

1

2198

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.0 [0.0, 0.0]

2.1 Uchida vs silver clip

1

2198

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Minor morbidity: total Show forest plot

1

193

Peto Odds Ratio (Peto, Fixed, 95% CI)

7.39 [0.46, 119.01]

4 Minor morbidity: details Show forest plot

1

193

Peto Odds Ratio (Peto, Fixed, 95% CI)

7.39 [0.46, 119.01]

4.1 Procedure related injuries with no additional operation

1

193

Peto Odds Ratio (Peto, Fixed, 95% CI)

7.39 [0.46, 119.01]

5 Technical failures Show forest plot

1

Peto Odds Ratio (Peto, Fixed, 95% CI)

Subtotals only

5.1 Uchida vs silver clip

1

2198

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.18 [0.08, 0.40]

6 Technical difficulties Show forest plot

1

Peto Odds Ratio (Peto, Fixed, 95% CI)

Subtotals only

6.1 Uchida vs silver clip

1

2198

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.97 [0.42, 2.24]

7 Failure rate (12 months) : total Show forest plot

2

3537

Odds Ratio (M‐H, Random, 95% CI)

0.21 [0.05, 0.84]

7.1 Pomeroy vs Filshie

1

1400

Odds Ratio (M‐H, Random, 95% CI)

0.22 [0.05, 1.02]

7.2 Uchida vs silver clip

1

2137

Odds Ratio (M‐H, Random, 95% CI)

0.19 [0.01, 3.95]

8 Operative time Show forest plot

2

2223

Mean Difference (IV, Fixed, 95% CI)

4.26 [3.65, 4.86]

8.1 Pomeroy vs Filshie

1

25

Mean Difference (IV, Fixed, 95% CI)

6.70 [0.77, 12.63]

8.2 Uchida vs silver clip

1

2198

Mean Difference (IV, Fixed, 95% CI)

4.23 [3.62, 4.84]

9 All complaints Show forest plot

1

Peto Odds Ratio (Peto, Fixed, 95% CI)

Subtotals only

9.1 Uchida vs silver clip

1

2137

Peto Odds Ratio (Peto, Fixed, 95% CI)

1.30 [0.92, 1.82]

10 Menstrual irregularities Show forest plot

2

2283

Odds Ratio (M‐H, Random, 95% CI)

1.43 [0.73, 2.79]

10.1 Pomeroy vs Filshie

1

146

Odds Ratio (M‐H, Random, 95% CI)

2.49 [0.88, 7.05]

10.2 Uchida vs silver clip

1

2137

Odds Ratio (M‐H, Random, 95% CI)

1.16 [0.90, 1.49]

11 Women's satisfaction Show forest plot

1

Peto Odds Ratio (Peto, Fixed, 95% CI)

Subtotals only

11.1 Uchida vs silver clip

1

2110

Peto Odds Ratio (Peto, Fixed, 95% CI)

1.27 [0.99, 1.64]

12 Surgeon's satisfaction Show forest plot

Other data

No numeric data
Figuras y tablas -
Comparison 4. Partial salpingectomy (PS) versus clip
Ir a la tabla de la revisión
Comparison 5. Hulka versus Filshie clip

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Minor morbidity: total Show forest plot

1

197

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.14 [0.00, 7.32]

2 Minor morbidity: details Show forest plot

2

Odds Ratio (M‐H, Random, 95% CI)

Subtotals only

2.1 Procedure‐related injuries with no additional operation

2

2322

Odds Ratio (M‐H, Random, 95% CI)

1.57 [0.73, 3.36]

2.2 Urogenital infection

1

1910

Odds Ratio (M‐H, Random, 95% CI)

2.40 [0.62, 9.30]

2.3 Wound complications

1

1910

Odds Ratio (M‐H, Random, 95% CI)

0.86 [0.63, 1.17]

3 Technical failures Show forest plot

2

2325

Odds Ratio (M‐H, Random, 95% CI)

1.04 [0.10, 11.33]

4 Technical difficulties Show forest plot

2

2323

Peto Odds Ratio (Peto, Fixed, 95% CI)

1.51 [1.09, 2.10]

5 Failure rate: total Show forest plot

1

1441

Odds Ratio (M‐H, Fixed, 95% CI)

6.20 [0.75, 51.66]

6 Operative time Show forest plot

1

197

Mean Difference (IV, Fixed, 95% CI)

0.70 [‐0.04, 1.44]

7 Complaints Show forest plot

1

Peto Odds Ratio (Peto, Fixed, 95% CI)

Subtotals only

7.1 Postoperative pain < 24 h

1

197

Peto Odds Ratio (Peto, Fixed, 95% CI)

1.74 [0.99, 3.03]
Figuras y tablas -
Comparison 5. Hulka versus Filshie clip
Ir a la tabla de la revisión