Clinical Outcomes and Patient-Reported Symptoms After Essure Removal Surgery: A Systematic Review

To evaluate clinical outcomes of Essure removal surgery, focusing primarily on symptom reduction and secondarily on indications for removal, quality of life (QoL), surgical technique and complications.

PubMed, Embase, and the Cochrane Library were searched.

Studies reporting outcomes of Essure removal were eligible; case reports and articles not in English or Dutch were excluded. Screening of 401 records identified 18 studies between 2014 and 2024, involving 2034 women in case series, prospective or retrospective cohorts, and 1 multicenter prospective study. No randomized controlled trials on this topic exist. Methodologic quality was assessed using the JBI critical appraisal checklist for case series: 16 studies were low, 1 moderate and 1 high risk of bias.

Significant symptom improvement, including pain reduction, reduction in abnormal uterine bleeding, and asthenia, was reported in 7 studies. Persisting or worse symptoms were reported. Significant QoL improvements were observed in 5 studies. The most frequent procedure was laparoscopic bilateral salpingectomy with device (52.3%), followed by laparoscopic removal and bilateral salpingectomy with cornua resection (17.5%) and hysterectomy (25.2%), of which 73.4% were laparoscopic. The overall complication rate was 6.5% (1.2% intraoperative, 5.3% postoperative).

Essure removal surgery is generally safe, and most patients report reduced pain, improved symptoms, and enhanced QoL. However, persistent or worsening symptoms occur. Evidence quality is limited owing to retrospective case series and cohort designs, absence of control groups, and heterogeneous, nonstandardized symptom and QoL measures.