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Practice Points

• Failure of surgical sterilisation is not de facto evidence of substandard operative technique but is generally worth screening medically
  
  
• If laparoscopic tubal surgery proves technically difficult, either the procedure should be converted to an open technique, or the interruption of the fallopian tube checked postoperatively by dye studies (hysterosalpingography)
  
  
• Incorrect anatomical placement of rings and clips is de facto evidence of substandard technique, and defence arguments of migration should be treated with scepticism
  
  
• Pathological and surgical studies show that most failures result from faulty operator technique
  
  
• With the current generation of Filshie clip, there is no proven instance of device failure

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