PIP: The purpose of this study is to review the experience at the Johns Hopkins Hospital with gastrointestinal complications conincident with 3600 laparoscopic sterilizations done between the years 1968 and 1972. Patients' ages ranged from 13 to 48 years and parity 0 to 13. All patients, after giving histories, received physical examination, menatocrit, urinalysis, and Papanicolaou smears. 80% were outpatients. Inpatients had medical illnesses that required preoperative evaluation or had come from long distances. 18% had previous abdominal surgery, which was not considered a contraindication. The 2 incision laparoscope technic was used in the first series of about 1000 pateints. The 1 incision, one burn technic was used for the second series of 1000 patients. A third series of 1600 patients were operated on using a 3 burn modification of the 1 incision technic. Gastrointestinal complications are those noted in the first 30 days after surgery. In 5 patients electrocoagulated segment of the bowel was recognized at laparoscopy and the extent of the lesion less than .5 cm. Only 1 had immediate laparotomy, and experience shows perhaps she could have been treated expectantly. A second group of 5 gastrointestinal injuries, not recognized at surgery, were delayed bowel perforations due to electrocoagulation. All were readmitted from the third to the seventh day after the operation. All required laparotomy and resection of the perforated segment of the bowel, which was in the terminal ileum in all 5 cases. 3 recovered promptly, 2 had complicated recoveries with septic pelvic thrombophlebitis in 1. She was eventually discharged on the 32nd day. All perforations occurred opposite the mesenteric border and microscopic study confirmed the causes as thermal coagulation. Perforation size varied from .5 to 4 cm. 1 traumatic bowel injury occurred at the time of the insertion of laparoscope trocar. In this case the small bowel was adherent to the anterior abdominal wall following a previous laparotomy. Simple repair resulted in recovery. Complications were equally frequent with each technic. The 11 cases of gastrointestinal complication represent .3% of the 3600 operations. Laparotomy was required in .2%. Metal tubal clips applied with laparoscopy may replace electrocoagulation and thus reduce complications.