Laparoscopic tubal ligation reversal

During a tubal ligation reversal, the blocked segments of the fallopian tubes are reconnected to the remainder of the fallopian tubes. This allows eggs to move again through the tubes and sperm to travel up the fallopian tubes to join an egg and thus making the pregnancy possible anew.

Tubal ligation procedures that cause the minimal amount of damage to the fallopian tubes are the ones which are most likely to allow a successful tubal ligation reversal. Tubal ligation reversal is more likely to be successful if the patient’s tubal ligation was originally done using clips or rings, rather than if segments of the fallopian tubes were burned in order to close them off. Procedures that cause scarring to seal off the fallopian tubes, such as the Essure or Adiana Systems, generally aren’t reversible and therefore not suitable for tubal ligation reversal. In such cases, in vitro fertilization (IVF) may be an option.

Tubal Ligation Reversal is done as a minimally invasive surgical procedure called Laparoscopic Tubal Reversal using small, specially-designed instruments to repair and reconnect the fallopian tubes. After general aesthesia, has been administered, a 10mm (less than ½-inch) tube (trocar) is inserted just at the lower edge of the navel, and a special gas is pumped into the abdomen to create enough space to perform the operation safely and precisely. The laparoscope (a telescope), attached to a camera, is brought into the abdomen through the same tube, and the pelvis and abdomen are thoroughly inspected. The fallopian tubes are evaluated and the obstruction (ligation, burn, ring, or clip) is examined. Three small instruments (5mm each, less than ¼-inch) are used to remove the occlusion and prepare the two segments of the tube to be reconnected. Once the connection (anastomosis) is completed, a blue dye is injected through the cervix, traveling through the uterus and tubes, all the way to the abdomen. This is to make sure the tubes have been aligned properly and that the connection is working well.

When performed by a trained laparoscopic tubal reversal surgeon, laparoscopic tubal reversal combines the success rates of micro-surgical techniques with the advantages of minimally-invasive surgery – namely faster recovery, better healing, less pain, fewer complications, and no large disfiguring scars.

The surgery usually takes about 2 to 3 hours and is done under general anaesthesia. .

A tubal ligation reversal isn’t appropriate for everyone. Your health care provider will consider various factors to determine if tubal ligation reversal is likely to be successful, such as:

• age and body mass index

• the type of tubal ligation procedure undergone previously
• Length of remaining fallopian tubes, and whether they still work properly
• Amount of scar tissue in the pelvic area
• Results of your partner’s sperm count and other fertility factors

If the remaining fallopian tubes are healthy, and the patient or their partner don’t have any other infertility issues, they have a good chance of getting pregnant after the tubal ligation reversal.

Overall, pregnancy success rates range from 30% to 85%. When pregnancy does happen, it’s usually within the first year after the reversal. Younger women — particularly those 35 and under — tend to have much better success rates of getting pregnant after the procedure.

You have to properly prepare before the tubal ligation surgery. During the pre-operational consultation, it is crucial that you tell your doctor everything that he needs to know about your previous health history and medicines that you take. He might recommend you stop taking some of those medications. The patient has the responsibility to inform the doctor of any concerns, worries or possible complications at the earliest possible time. The surgeon or a nurse will advise the patient about any additional procedures that are needed before the operation. During the pre – surgery consultation our doctor will review your medical and surgical history and decide if tubal ligation reversal can be successful for you.

The doctor will discuss your prior surgery as well as consider your current situation. Factors such as age, pregnancy history, body weight, health status, history of infections and more may all play a role in your decision to proceed with the procedure.  After reviewing this information, the doctors may offer you further testing to increase your chances of becoming pregnant after the surgery. Many patients undergo testing to assess their general health and their heart condition before their procedure. Some patients are asked to obtain cardiology clearance before proceeding with the operation.

The doctors may make recommendations and the patient takes full responsibility to follow these recommendations.

Some women may need to stay in the hospital for 1 to 3 days. These days, tubal reversal surgery is most often done using “microsurgical” techniques. An overnight hospital stay may not be always necessary. Women who have the microsurgical method usually go home on the same day, typically within couple of hours after the surgery.

Patients are seen between 5–7 days after the operation to look at the small incisions and remove any stitches if necessary. Most of the time, the few stitches that were placed will be under the skin and will be absorbed by the body, without need for removal.

Majority of women go back to their normal activities within 2 weeks after the procedure.

Patients should wait two to three months prior to attempting pregnancy in order to give the tubes a chance to heal completely. Trying to conceive before could result in an increased risk of ectopic pregnancy (pregnancy inside the fallopian tube instead of in the uterus). After a tubal ligation and then tubal reversal, the tube has been operated on twice and scar tissue can form that keeps the fertilized egg from moving through the tube correctly. It is mandatory that you seek early prenatal care from your doctor as soon as you think you might be pregnant. You will need to have blood tests and ultrasound(s) done to be sure that your baby is growing in your uterus. It also recommended that you take folic acid (400-1000 mcg) daily. This has been proven to lower the chance of your baby having a neural tube defect, or spina bifida. It is important that you start this before you get pregnant.

After tubal reversal, if pregnancy is not achieved after a few months, don’t get too upset or worried. In the practical study of patients, pregnancy can occur on average from 6 months to a year. These results are related to the fertility of both parents.

Even if the tubal reversal surgery is successful, and the tube is open all the way through, there is no guarantee that the tube will work correctly. The fallopian tube has tiny hair-like cells called cilia that help to move the fertilized egg into the uterus. There is no way to control the function of the cilia at the time of surgery. Smoking does decrease the ability of the cilia to work correctly, as well as decreasing fertility rates in general.

You need to consider that after a tubal reversal procedure is the increased risk of ectopic, or tubal pregnancy. After a tubal ligation and then tubal reversal, the tube has been operated on twice and scar tissue can form that keeps the fertilized egg from moving through the tube correctly. It is mandatory that you seek early prenatal care from your doctor as soon as you think you might be pregnant. You will need to have blood tests and ultrasound(s) done to be sure that your baby is growing in your uterus. It also recommended that you take folic acid (400-1000 mcg) daily. This has been proven to lower the chance of your baby having a neural tube defect, or spina bifida. It is important that you start this before you get pregnant.

There is a chance of complications with any type of surgery, although the risks associated with tubal reversals are relatively low. Tubal ligation reversal is abdominal surgery, which as any other surgery carries a risk of infection, bleeding and injury to nearby organs, as well as risks related to anaesthesia.

Infection is unusual after this type of surgery. Should an infection occur, treatment including antibiotics or additional surgery may be necessary.

Complications that may appear include: allergic reactions to medications, anaesthetic agents or solutions used, in rare cases, local allergies to tape, suture material, or topical preparations. Headaches, itching, medication side-effects, heartburn/reflux, bruising, general weakness, anaesthetic complications, sore throat, dizziness, blurred vision, shivering or minor wound problems. Although the majority of patients do not experience these complications, you should discuss each of them with your surgeon to make sure you understand the risks, potential complications and consequences of tubal ligation reversal.