Tubal sterilization: Complications of laparoscopy and minilaparotomy

OBJECTIVE: To evaluate whether intra- and post-operative morbidity varies according to the method used for female sterilization. STUDY DESIGN: The database of the Swiss obstetric study group was analyzed for a period of 9 years. After the exclusion of cases with extraneous factors that may have influenced the operative outcome, three groups of patients were identified: (1) interval laparoscopic sterilization unrelated to pregnancy (n=20,325); (2) postpartum laparoscopic sterilization (n=2233); (3) postpartum sterilization by minilaparotomy (n=5095). Intra-operative and post-operative complications were compared according to the surgical approach. RESULTS: A total of 27,653 patients were included in the study. The proportion of major complications was higher in group 3 than in group 1 (0.39% versus 0.10%, odds ratio 4.0, 95% CI 2.15-7.44, p<0.001) but not statistically different between groups 1 (0.10%) and 2 (0.18%). Minor complications were statistically significantly more frequent in group 3 (0.82%) than in group 1 (0.26%) or group 2 (0.27%). There was no case of intra-operative or post-operative death in the study population. CONCLUSION: When available, a laparoscopic approach should be chosen for female sterilization. After uneventful pregnancy course and delivery, it does not seem justified to delay the endoscopic sterilization to a later time.

同胞の「帰還」 : カザフスタンにおける在外カザフ人呼び寄せ政策

カザフスタンは独立後，帝政ロシアおよびソ連時代の植民地的政策や戦乱によって離散した同胞を呼び寄せ，少数派に甘んじていたカザフ人人口を増大させて，共和国を名実ともにカザフ人の国家とすることを目指した。カザフ人のみを優遇する移民政策は世論の強い反対もなく，当面維持される可能性が高い。これは権威主義体制の下で非カザフ人の民族的異議申し立てが封じ込まれているほか，カザフスタンではむしろ現地のカザフ人のあいだで言語的・文化的ロシア化が進行しており，異文化に同化した在外同胞は排除すべきだという主張がされにくいことなどが背景にある。しかし在外同胞の招聘は当初の政治目的を失いつつある。ロシア人らの大量出国によって短期間でカザフ人の人口的優位が確立し，民族構成を変化させるツールとしての在外同胞呼び寄せの重要性は薄れたからだ。カザフ人移民はもはや同胞というだけでは歓迎されず，労働力としての「質」を問われ始めている。