before i say anything, not a doctor, just sharing my thoughts and feelings.

Okay, so what he's saying is technically correct because he's just quoting studies at you. bi-salps (complete tube removal) data get lumped in with tubal ligation data because both methods fall under sterilization. People who do the research haven't created separate data pools yet for the two so technically nexplanon and sterilization are about the same. but the few times they have looked at the two methods separately (bi-salps vs tubal ligation) bi-salps have a much lower failure rate. usually when someone says they got pregnant after getting sterilized it's usually a failed tubal ligation or filshie clips. Here is a link with all studies about failed bi-salps. at this time there are only 5 confirmed failed cases (4 out of the 5 were nonviable pregnancies). and 1case that was never confirmed. Even though I would never encourage using social media as a source... i can't help but noticed there are little to none social media posts on the internet of people talking about getting pregnant after a bi-salp. it's very rare.

This is purely my opinion and not medical advice nor am I sure it research to back it up, but yes, in my opinion think a bi-salp is more effective than nexplanon.

also every doctor will always tell you surgery is risky no matter how healthy you are. it's just a standard disclaimer they put out there (that's not mean to take the advice lightly though).