Tubal Ligation Reversal

Women make a decision not to bear children any longer but later wish to alter the same. In the United States, about 650,000 women opt for tubal ligation; this stops them from bearing a child any further. For some reason most of the women wish to alter their decision at some point of their child bearing phase. Women with their tubes tied need no longer worry about being infertile as tubal ligation reversal can bail them out. 25% of the women who have undergone tubal ligation opt for tubal reversal within five years.

What is tubal reversal?

Tubal ligation reversal or tubal sterilization reversal is termed as tubal reversal in short. It is a surgical process that reinstates the fertility in any woman. The separated sections of the fallopian tube are joined together through this process. Tubal reversal gives the opportunity for any woman to conceive yet again naturally. This surgery is usually performed by a reproductive surgeon who has specialized and has gained thorough knowledge in tubal ligation reversal techniques.

Tubal reversal process

While settling in for a tubal reversal process it is advisable for the person to provide all related records pertaining to tubal ligation undergone by that person. A microsurgery is performed to re-connect the two ends of the fallopian tube. One section of the fallopian tube called the proximal tubal segment surfaces from the uterus and the other section called the distal tubal segment comes to an end in the fimbria that is located close to the ovary. These two segments of the fallopian tube are re-connected through tubal reversal.

Tubal reversal can be done precisely provided the two cut-ends of the fallopian tube measure the same in diameter. In case the diameter of the two tube-ends varies, the success rate for pregnancy could turn out to be low. The success for tubal reversal is also dependent on the length of the fallopian tube after the reversal process. Original length of the fallopian tube is roughly about 8 inches, after the reversal process the tube should measure about 3-4 inches.

The person opting for tubal reversal should stay back in the hospital for a night, in few cases the stay might further extend for a couple of days. The entire process takes roughly about one to two hours. Tubal reversal can be carried out either by administering general anesthesia or local anesthesia. The patient recovers from the surgery within four to six weeks.

Tubal reversal methods

Laparoscopic tubal reversal: This type of surgery is the least-invasive surgical process. Small instruments that are specifically-designed are utilized to repair and re-connect the fallopian tubes.

• General anesthesia is administered to the patient and a 10mm trocar (tube) is introduced into the lower edge of the navel and a special gas is pumped into the abdomen.
  
• This gas creates sufficient space in the abdomen to perform the surgery correctly.
  
• The pelvis and the abdomen are inspected through a laparoscope that is taken into the abdomen through the trocar.
  
• The obstruction in the tube is also studied; the obstruction could be a rim, clip, ligation or burn.
  
• Three special and small instruments measuring 5 mm are utilized to remove the obstruction and ready the two separated sections of the fallopian tube to be re-connected.
  

Re-joining the tubes can be established using a tubal cannulator which is inserted into the uterus via the cervix thus permitting the tube to be threaded along with a fine stent. Tiny sutures are made to re-connect the two segments of the fallopian tube. Once the tubes are connected, this process is called anastomosis; a blue colored dye is injected through the cervix into the tubes and into the uterus. The uninterrupted flow of the dye ensures flawless re-connection of the fallopian tubes.

All the instruments are taken out of the abdomen and the gas in also removed. The patient can go home after three hours of the operation and should come back for a review after 5-7 days. Sutures are absorbed by the body. It is advisable for the patient to conceive after three months after the procedure so as to avoid ectopic (pregnancy in the tube) pregnancy.

• This procedure is the least-invasive when compared to other methods.
  
• Recovery is faster.
  
• Pain is very minimal.
  
• Hardly any complications.
  
• No scars.
  

Microsurgery:

Microsurgery is used for tubal legation reversal process; through microsurgery the two segments of the fallopian tube are re-connected. Microsurgery handles the body tissues gently and utilizes very thin needles to re-join the tube.

• Very small sutures aid in quick healing.
  
• Reduces tissue damage.
  
• Reduces bleeding during the surgery.
  

Mini-laparotomy tubal reversal:

A tiny incision is made just beyond the pubic bone on the abdominal wall. Local anesthesia is administered on the chosen spot and the surgery is performed. Microsurgical instruments used for the procedure guarantee perfect suturing of the fallopian tube. The instruments used for this surgery are similar to the ones used in a laparoscopic surgery.

• The scar is hardly visible after it heals as the incision is made just above the pubic hairline.
  
• Post-operative pain and discomfort is minimal.
  

Ampullary salpingostomy:

This process is used when tubal ligation was performed an unusual method called fimbriectomy (fimbrial portion of the fallopian tube close to the ovary is removed; the tubal portion is attached to the uterus).

Tubotubal anastomosis:

The block in the two sections of the fallopian tube is opened up and a slender and pliable stent is fit to re-join the tube. Microsurgical sutures ensure proper alignment of the tube. After re-connecting the tube the stent is gently removed. Patients have to check with their respective healthcare providers for the method of tubal reversal they follow in their hospitals.

• Relief from symptoms of post tubal ligation syndrome such as
  
  1. Heavy, painful, irregular periods
     
  2. Symptoms for early menopause
     
  3. Ectopic pregnancy
     
  4. Vaginal dryness
     
  5. Palpitations
     
  6. Hot and cold flashes
     
  7. Trouble to sleep
     
  8. Worse premenstrual syndrome
     
  9. Libido loss
     
• Remarriage thus wishing to have issues through new partner
  
• Sudden death of a child
  
• Sudden desire to have more children through the existing marriage
  
• Any religious or spiritual reasons
  

Success rate for tubal reversal

Success rate for tubal reversal varies from 20% to 70%. Success in tubal reversal is dependent on various factors such as:

• The type of tubal ligation done earlier.
  
• Damage caused through the tubal ligation process.
  
• Age of the person seeking tubal reversal. Women aged over 40 should speak to their physician before opting for this process.
  
• How healthy the patient's fallopian tubes are.
  
• Sperm count of the partner.
  
• Egg production of the patient.
  

In general tubal reversal success rate is high in women who have:

• Rings or clips are placed around the fallopian tube in the tubal ligation process.
  
• A small section of the tube is removed through tubal ligation process.
  

A fee of US$3,000 to US$10,000 is charged by the physician for the process. Hospital charges vary for various hospitals according to the facilities offered by them.

• Excessive bleeding
  
• Infection
  
• Complications due to anesthesia
  
• Damage to the nearby organs
  
• Risk of ectopic pregnancy
  

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