Tubal Reversal Procedure Improves

     Tubal ligation for the purpose of pregnancy prevention is one of the more common means of birth control in the United States. However, this is a permanent method of contraception. If a women changes her mind and wishes to attempt another pregnancy, she requires another surgical procedure. This operation is known as a reversal of tubal ligation or microsurgical tubal re- anastomosis.

     Tubal reversals have been performed since 1970. In the past, the procedure required a long incision, and usually a lengthy, two-three day hospital stay. Its costs was $10,000-$15,000. Specially trained surgeons are now able to perform an out-patient procedure called mini-laparotomy. It requires a small incision in the abdomen, less than 23 hours of post-surgical observation, and has a short (7-10 day) recovery. The cost of this newer procedure is approximately $6,000-7000 (this includes the hospital stay).

     This procedure employs the use of several very thin stitches to carefully put the fallopian tubes back together. The sutures are as fine as a human hair. As a result, it is necessary to use an operating microscope or magnifying eye wear to adequately magnify and visualize the tubal anatomy and structure, making for a precise and tedious surgery. The procedure is performed under general anesthesia. It takes about two to three hours to complete, and patients usually tolerate the surgery well. After going home, patients may require a few days of pain control medication and are restricted from lifting and exercising for two weeks after surgery. They have no dietary restrictions and are able to drive, walk, use stairs, and go out within a few days.

     Appropriate patient selection prior to this procedure is important. The success of this type of surgery depends upon several factors including the patient's age, health and physical condition, and of utmost importance is the length of the fallopian tubes remaining after the tubal ligation. This can usually be determined by reviewing the operative report from the sterilization surgery. Ideally 4 cm. (about 1 inch) of healthy tubes are needed to qualify for the reversal procedures.

     Another important factor in determining the success of tubal reversal is the expertise of the surgeon. It is a complicated procedure requiring special training and extensive experience performing micro-surgery.

     It is also important to be aware that when a woman becomes pregnant after a tubal reversal, there may be a higher risk for tubal pregnancy, a condition where the fetus becomes lodged in one of the fallopian tubes rather than inside the uterus. The expected overall pregnancy rate is usually about 60-80% with tubal pregnancies occurring in about 5-8% of the cases. Pregnancy can be achieved from the first month after the procedure and throughout the first two years after the procedure.

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