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Tubal Reversal Procedures

How Tubal Reversal is Performed

Tubal ligation reversal surgery involves microsurgical techniques to open and reconnect the fallopian tube segments that remain after a tubal ligation procedure. The type of microsurgical technique used to repair the fallopian tubes depends on how much of the tube segments are left.

Microsurgical Tubal Anastomosis

Usually there are two fallopian tube segments remaining after tubal ligation surgery - the proximal tubal segment that is connected to the uterus and the distal tubal segment that ends with the fimbria next to the ovary. The procedure that connects these separated parts of the fallopian tube is called microsurgical tubotubal anastomosis, or tubal anastomosis for short. Other terms used to describe this procedure are microsurgical tubal reanastomosis, microsurgical tubal reversal or microsurgical tubal repair.

After opening the blocked ends of the remaining tubal segments, a narrow flexible stent is gently threaded through their inner cavities or lumens into the uterine cavity. This ensures that the fallopian tube is open from the uterine cavity to its fimbrial end.

Tubal Anastomosis #1

The newly created tubal openings are then drawn next to each other by placing a retention suture in the connective tissue that lies beneath the fallopian tubes. The retention suture avoids the likelihood of the tubal segments subsequently pulling apart. Microsurgical sutures are used to precisely align the muscular portion and outer layer. The tubal stent is then gently withdrawn from the fimbrial end of the tube.

Tubal Reversal - Tubal Anastomosis #2 Tubal Anastomosis #2

Microsurgical Tubal Implantation

In a small percentage of cases, a tubal ligation procedure leaves only the distal portion of the fallopian tube and no proximal tubal opening into the uterus. This may occur when monopolar tubal coagulation has been applied to the isthmic segment of the fallopian tube as it emerges from the uterus. In this situation, a new opening can be created through the uterine muscle and the remaining tubal segment inserted into the uterine cavity.

This microsurgical procedure is called tubal implantation. Dr. Storment performs microsurgical tubal implantation if microsurgical tubal anastomosis is not possible due to the absence of a proximal tubal segment and interstitial tubal lumen. HOWEVER, he generally recommends IVF in patients like this because of the extraordinarily high rate of tubal pregnancies after this procedure. If a patient becomes pregnant after this procedure there is a greater than 75% chance it will be an ecoptic or TUBAL PREGNANCY.

Tubal Reversal - Tubal Implantation Tubal Implantation

Fimbriectomy Reversal  

There are some physicians who still recommend tubal repair after a fimbriectomy, but because of the very high rate of ectopic pregnancies, Dr. Storment recommends IVF for these patients. 

Repair of Hydrosalpinx

A hydrosalpinx is a fallopian tube closed at its fimbrial end with fluid in it. It is usually caused by prior infection due to sexually transmitted diseases. In the case of hydrosalpinx, the ciliary lining at the fimbrial end of the fallopian tube may be damaged. There are some physicians who still recommend tubal repair for a hydrosalpinx, but because of the very high rate of ectopic pregnancies, Dr. Storment recommends IVF for these patients. Many times he will recommend removal of these tubes prior to IVF simply to prevent the toxic fluid contained within the tubes from interfering with a pregnancy implanting in the uterus. MOST women who have had a tubal ligation do not have a hydrosalpinx.