Tubal Reanastomosis – Tubal reanastomosis, also known as tubal reversal, can be performed to reverse a tubal ligation. There are many types of tubal ligations and not all can be reversed. A tube is normally 9 – 11 cm in length (approximately 3-4 inches) and success rates are highest if there is more than 4-5 cm (1 ½ – 2 inches) of continuous tube after reversal. The less damage done to the tube at ligation, the higher the success rate (i.e., using “clips” or “loops” produces the least amount of damage and has a better chance of success). If the end of the tube is removed, it is unlikely any surgical procedure will be successful. Providing a copy of the operative note helps us to determine the type of ligation that was performed, the extent of the damage and the potential for reversibility. If a pathology report is available, it can also be helpful in assessing how much tube was removed. A hysterosalpingogram (HSG) may help determine how much tube remains near the uterus for reversal and the location for the reversal. Tubal damage that is internal secondary to infection or endometriosis is usually not possible to correct with surgery; in vitro fertilization (IVF) is most often the best option under these circumstances.

A tubal reanastomosis is generally performed through a “mini-lap” (smaller incision). The size of the incision is based on the size of the patient and previous surgeries. The average patient can return to work in two to four weeks. Pregnancy rates may be as high as 70-80% (over a two-year period) for women who have regular cycles and have healthy tubes for repair.

Unless we are certain ahead of time that the tubes are reversible, we prefer to perform a laparoscopy prior to performing any major surgery. A laparoscope is an endoscope-like instrument similar to a telescope. By making a small incision in the belly button, we are able to view the pelvis to determine the status of the tubes, ovaries, and uterus. It is then much easier to decide whether a tubal reversal is feasible. If other pelvic pathology is found, such as scarring and/or endometriosis, the chances of the tubal reversal being successful may be markedly lower.

A laparoscopy the day of reversal is performed first if operative notes and/or pathology reports are not available or suggest a poor chance of reversal success.