Removal of etonogestrel contraceptive implants in the operating theater: report on 28 cases

ObjectivesWe describe removal procedures for etonogestrel contraceptive implants in the operating theater. In addition, we discuss the management of removal of contraceptive implants that are difficult to palpate or are impalpable.DesignWe conducted a retrospective single-center case series analysis of Implanon™ removals conducted at a university hospital between January 2002 and April 2005.Materials and MethodsWe analyzed case notes for 28 patients who had their contraceptive implant removed in the operating theater.ResultsIntermenstrual bleeding was the principal reason for removal (52.4%). Ten patients already had one attempted removal of their implant. Preoperative ultrasound localized the implant in all cases. Half of the removals were done under local anesthetic, with three cases progressing to general anesthesia (11%). Thirty percent of the implants had migrated from their initial implantation, 37% were in intramuscular tissue and 11% were in the humeral neurovascular sheath. The only postoperative complications were one small seroma and transient paresthesia in the territory of the ulnar nerve. The implant was not found in one case.ConclusionsThe removal of an implant that is not palpable or difficult to palpate should take place in the operating theater following localization by ultrasound. Patients must be fully informed about the procedure, including its complications and the risk for failure.