The Journal of the American Association of Gynecologic Laparoscopists
Original ArticlesPelviscopic Reversal of Tubal Sterilization with the One- to Two-Stitch Technique
Section snippets
Materials And Methods
From 1995 to 1999, 35 women (age range 26–40 yrs) who had undergone tubal sterilization within the last 2 to 10 years requested reversal of tubal occlusion. The maximum interval between sterilization and reversal was 10 years; in over 70% of patients it was 1 to 3 years. Of two surgical techniques available, we did only end-to-end anastomosis. Tubal reimplantation (cornual-isthmic anastomosis) was not performed due to low pregnancy rates in earlier patients.
Results
Seven of 35 women underwent only diagnostic laparoscopy to estimate tubal length and motility, to inspect the peripheral end, and to determine general patency. In 28 patients we performed 22 bilateral and 6 unilateral reversals (Table 1). Eight bilateral reversals were isthmic-ampullary and 14 isthmic-isthmic. One unilateral reversal was isthmic-ampullary and five were isthmic-isthmic. Average operating time for bilateral end-to-end anastomosis was 110 minutes and for seven diagnostic
Discussion
Despite progress achieved by in vitro fertilization and embryo transfer (IVF-ET), the live birth rate associated with the procedure is only 25%. It is therefore understandable that tubal reversal is once again being discussed. Many women with infertility due to a tubal problem who have no success with IVF-ET often request tubal anastomosis. Although only 28 interventions were performed in this study, the high success rate shows that these operations can be performed laparoscopically if the
Conclusion
Laparoscopic microsurgical tubal anastomosis is an alternative to microsurgical laparotomy for patients requesting reversal of tubal sterilization, and in our department has replaced laparotomy. The high pregnancy rate justifies these surgical interventions. To ensure the best outcomes, the surgeon should be experienced in microsurgical tubal anastomosis by laparotomy and in operative laparoscopic procedures, and careful patient selection is crucial.
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