An Analysis of Patients Undergoing Surgical Removal of the Essure Device: A Retrospective Case Series

Objective: The aim of this research was to describe and investigate characteristics of patients who underwent surgical removal of the Essure^® device (Bayer, Whippany, NJ). This device was the first transcervical micro insert device for permanent sterilization. Materials and Methods: A retrospective chart review was conducted at an academic hospital on patients undergoing surgical removal of the Essure device from 2014 to 2017. Results: A total of 69 patients underwent Essure removal-25 via laparoscopic hysterectomy, 38 via salpingectomy with cornual resection, and 6 via salpingectomy without cornual resection. The mean age of the subjects was 36.4 years (standard deviation [SD] = 7.2). The mean body mass index was 31.7 (SD = 7.3). The most-commonly reported past medical histories were anxiety (19/69) and depression (16/69). Thirty-eight patients had histories of prior surgeries, with cesarean section being reported most commonly (22/38). The most-frequently cited Essure-attributed symptoms were pelvic pain (63/69), bleeding (34/69), and bloating (15/69). When removal was requested, 58/69 patients had had the device in for >1 year and 44/69 patients reported onset of symptoms at time of placement. During the removal surgery, 59/69 patients had additional pelvic intraoperative findings; specifically, 43/69 had endometriosis, 24/69 had adhesions, 22/69 had adenomyosis, 8/69 had fibroids; and 7/69 had misplaced coils. The majority of fallopian tubes were normal/no pathologic alterations (35/69), with smaller subsets of patients having paratubal cysts (26/69) and fibrosis (5/69). Conclusions: Patients seeking removal of the Essure device might have coexisting pelvic pathology. Providers should be prepared to address any intraoperative pathology found.