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Normal patency was restored to the right fallopian tube of a 41-year-old sterilised woman by laparoscopic tubotubal reanastomosis. We believe that this is the first report of this procedure in Australia. Laparoscopic tubotubal reanastomosis combines the high success rates of microsurgical tubotubal reanstomosis with the advantages of the laparoscopic approach.

The author describes a simple macrosurgical technique he developed in 1974 specifically for reversal of sterilization by tubal anastomosis. The technique was used on 14 patients aged 29 to 40 years. In terms of tubal patency 22 Fallopian tubes out of 28 (70%) were successfully anastomosed and had patency demonstrated after the operation by means of hysterosalpingography. In terms of intrauterine pregnancies 6 patients (43%) have had pregnancies to date and 6 (43%) have not conceived as yet. The success of tubal reconstruction after occlusion depends largely on the conservative nature of the original occlusive procedure. One or other method of clip sterilization may be the current method of choice for long-term fertility control. Contraindications to tubal anastomosis include: 1) general illness adversely affected by pregnancy; 2) general or local illness which indicated original sterilization and 3) family history suggestive of inheritable illness.

15 patients underwent either unilateral or bilateral microsurgical reanastomosis. The technique involved paring back the tubal scar area until patency could be demonstrated with methylene blue. Suturing into the muscular layer under microscopic visualization was then performed over a ureteric catheter by interrupted 6/0 or 8/0 nonabsorbable sutures. Additional sutures were used to repair the serosa and mesosalpinx after which the catheter was removed. No splints corticosteroids or antibiotics were used. Of the 6 patients whose operations were performed over 6 months preceding the time of writing and who were available for follow-up 2 had become pregnant the 1st at 13 months. It is suggested that to increase potential reversibility sterilizations should be performed so as to destroy no more than 5-10 mm of the tube and to leave at least 1 cm of medial tubal stump.