August 24, 2016

Tubal Reversal

Tubal reanastomosis or tubal reversal, is the surgery that is done to restore fertility after tubal ligation or “tubes tied”. When a woman elects to have permanent sterilization or “gets her tubes tied”, a surgery is done to block, burn, or cut a portion of the fallopian tube. This prevents the sperm from reaching the egg to create a pregnancy. The surgery is done immediately after childbirth by an incision in the abdomen, or during a cesarean section. Tubal ligation can also be done laparoscopically remote from childbirth.

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Tubal Reanastomosis Surgery

Tubal reanastomosis surgery is done to restore fertility, sometimes many years after tubal ligation. Tubal reanastomosis surgically opens the fallopian tubes to allow the sperm to reach the egg.

An incision is made in the abdomen to see the fallopian tubes. The fallopian tube diameter is very small, less than a quarter inch. Microscopic surgery is needed to see the tubes, and to allow the surgeon to see the very tiny sutures that are necessary to stitch the tubes together. The tubes are first visualized under the microscope. The blocked ends are opened to allow unobstructed passage. These ends are then stitched together by a series of microscopic sutures to form a normal fallopian tube. After three months of healing, the tubes function normally in over 75% of cases.

Not every fallopian tube is a candidate for reanatomosis. The tube needs to be of a certain length, usually greater than 2.5cm. The diameter of the two pieces also needs to be similar so the two ends match when they are brought together. Some women are not candidates for a tubal reversal, because of the presence of scar tissue, either from previous surgery or previous infection. The scar tissue blocks the access to the tubes at the time of surgery and makes the very delicate tubal reanastomosis difficult. Scar tissue also can destroy the inside of the tubes, impairing the passage of the sperm and egg.

Laparoscopic surgery is done at the time of the reanastomosis prior to making an incision. Laparoscopy allows the surgeon to inspect the tubes first to see if the reanastomosis can be done. If the reanastomosis can be done, then an incision is made and the surgery is completed.

Reanastomosis surgery carries a 1 in 400 risk of complications such as bleeding, infection, and damage to the organs that are surrounding the surgical site.

Tubal reversal surgery is same-day surgery and takes between two and four weeks to recover.

The success rate is greater than 75% for pregnancy.