Inferior epigastric haemorrhage, an avoidable complication of laparoscopic clip sterilization

Forty laparoscopists were questioned as to their preferred site for introducing a Samaritan clip applicator during sterilization procedures. The introduction sites were compared with the location recommended by Lieberman (1976) and with the surface anatomy of the inferior epigastric vessels. Of those gynaecologists questioned, only 12% used a site within 1 cm of that recommended by Lieberman; 25% used a site within 1 cm of the epigastric vessels as suggested by surface anatomy. It is proposed that a second puncture site in the midline or at the lateral border of the rectus muscle should be used to avoid the complication of inferior epigastric vessel trauma at laparoscopic sterilization procedures.