Search

• A meta-analysis including 14,113 patients with tubal reversal after tubal ligation. • This is one of the biggest cohorts ever collected. • A main result of 65.3% pregnancy rate. • Age is a significant factor for pregnancy rate. Between 20% and 30% of women who have undergone tubal ligation regret their decision. The alternative to regain fertility for these women is either in vitro fertilization or tubal re-anastomosis. This article presents a systematic review with meta-analysis to assess the current evidence on the efficacy of tubal recanalization surgery in patients who have previously undergone tubal ligation. The search was conducted in the World of Science (WOS) database, The Cochrane Library and ClinicalTrials.gov record using the keywords "tubal reversal", "tubal reanastomosis" and "tubal anastomosis". The review was carried out by two of the authors. Data from 22 studies were evaluated, comprising over 14,113 patients who underwent the studied surgery, following strict inclusion criteria: articles published between January 2012 and June 2022, in English and with a sample size bigger than 10 patients were included. A random-effects meta-analysis was performed. The overall pregnancy rate after anastomosis was found to be 65.3 % (95 % CI: 61.0–69.6). The percentage of women who had at least one live birth, known as the birth rate, was 42.6 % (95 % CI: 34.9–51.4). Adverse outcomes after surgery were also examined: the observed abortion rate among women who underwent surgery was 9.4 % (95 % CI: 7.0–11.7), and the overall ectopic pregnancy rate was 6.8 % (95 % CI: 4.6–9.0). No differences were found between the outcomes when differentiating surgical approaches: laparotomy, laparoscopy, or robotic-assisted surgery. The patient's age was identified as the most significant determining factor for fertility restoration. Finally, when comparing the results of tubal reversal with in vitro fertilization, reversal procedures appear more favorable for patients over 35 years old, while the results are similar for patients under 35 years old, but more data is needed to evaluate this finding. Therefore, the available literature review demonstrates that surgical anastomosis following tubal ligation is a reproducible technique with relevant success rates, performed by multiple expert groups worldwide. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effectiveness of laparoscopic tubal anastomosis for tubal occlusions associated with infertility in patients with previous laparoscopic salpingostomy for ectopic pregnancy. Methods: This study is a retrospective analysis of the pregnancy outcomes of 173 infertile patients who underwent hysteroscopy and laparoscopic tubal anastomosis treatment between January 2013 and August 2018 in the Department of Reproductive Endocrinology in West China Second University Hospital of Sichuan University. All patients had a history of laparoscopic salpingostomy for tubal pregnancy. The primary outcomes were intrauterine pregnancy, ectopic pregnancy, and delivery rates. We further studied the associated factors that could influence the change in pregnancy status. Results: The 24‐month cumulative clinical pregnancy rate of all patients was 107/173 (61.8%). The distribution of outcomes for the entire group of pregnancies was as follows: intrauterine pregnancy rate, 76/173 (43.9%); ectopic pregnancy rate, 31/173 (17.9%); delivery rate, 68/173 (39.3%); and miscarriage rate, 8/173 (4.6%). Age, type of anastomosis, hydrosalpinx, and endometrial polyps were significant prognostic factors in the multivariate model. Conclusion: Laparoscopic tubal anastomosis is an effective treatment for tubal‐associated infertility due to previous laparoscopic salpingostomy for ectopic pregnancy, especially for women under 35 years of age. Laparoscopic tubal anastomosis is an effective treatment for tubal‐associated infertility after laparoscopic salpingostomy for tubal pregnancy. [ABSTRACT FROM AUTHOR]

Objective: The goal of this research was to evaluate fertility outcomes after laparoscopic tubal anastomosis for reversal of tubal sterilization, and assess this procedure's place as an alternative to assisted reproductive technology (ART). Materials and Methods: This retrospective cohort study was conducted between January 1, 2011 and mid-May 2017. Data were collected retrospectively from patients with tubal clips, who underwent laparoscopic tubal anastomosis performed by a specific surgeon during the study period, in a secondary Belgian medical unit. Results: Twenty-three patients underwent reversal surgery with a follow-up time ranging from 4 months to 6 years. The patients' ages were between 29 to 42 (average: 35.6 years; standard deviation [SD]: 3.2) at the time of the surgery. Average surgery duration was 104.2 minutes (SD: 26.4; range: 64–157 minutes). No intraoperative or postoperative complications were reported. A 61% spontaneous pregnancy rate was achieved (100% <30 years; 42.8% 30–34 years; 66.6% 35–39 years; and 66.6% ≥ 40 years). Average time to conceive was 171 days (SD: 194.5; range: 10–743 days). Of the patients who became pregnant after the surgery, 42.8% reported 2 or more pregnancies. Also reported were: 11/25 live births (44%); 7/25 early miscarriages (28%); 1/25 ectopic pregnancies (4%); 3/25 abortions (12%); and 3 ongoing pregnancies (12%). Conclusions: Bilateral tubotubal anastomosis is effective for women wanting to restore their fertility after tubal sterilization and should be proposed as an alternative to ART. Randomized controlled trials comparing in vitro fertilization with tubotubal anastomosis are needed in order to lead to a conclusion. (J GYNECOL SURG 34:115) [ABSTRACT FROM AUTHOR]

Background: Female sterilization is one of the most common contraceptive methods. A small number of women, however, opt for reversal of sterilization procedures after they experience regret. Procedures can be performed by laparotomy or laparoscopy, with or without robotic assistance. Another commonly utilized alternative is IVF. The choice between surgery and IVF is often influenced by reimbursement politics for that particular geographic location.Objective and Rationale: We evaluated the fertility outcomes of different surgical methods available for the reversal of female sterilization, compared these to IVF and assessed the prognostic factors for success.Search Methods: Two search strategies were employed. Firstly, we searched for randomized and non-randomized clinical studies presenting fertility outcomes of sterilization reversal up to July 2016. Data on the following outcomes were collected: pregnancy rate, ectopic pregnancy rate, cost of the procedure and operative time. Eligible study designs included prospective or retrospective studies, randomized controlled trials, cohort studies, case-control studies and case series. No age restriction was applied. Exclusion criteria were patients suffering from tubal infertility from any other reason (e.g. infection, endometriosis and adhesions from previous surgery) and studies including <10 participants. The following factors likely to influence the success of sterilization reversal procedures were then evaluated: female age, BMI and duration and method of sterilization. Secondly, we searched for randomized and non-randomized clinical studies that compared reversal of sterilization to IVF and evaluated them for pregnancy outcomes and cost effectiveness.Outcomes: We included 37 studies that investigated a total of 10 689 women. No randomized controlled trials were found. Most studies were retrospective cohort studies of a moderate quality. The pooled pregnancy rate after sterilization reversal was 42-69%, with heterogeneity seen from the different methods utilized. The reported ectopic pregnancy rate was 4-8%. The only prognostic factor affecting the chance of conception was female age. The surgical approach (i.e. laparotomy [microscopic], laparoscopy or robotic) had no impact on the outcome, with the exception of the macroscopic laparotomic technique, which had inferior results and is not currently utilized. For older women, IVF could be a more cost-effective alternative for the reversal of sterilization. However, direct comparative data are lacking and a cut-off age cannot be stated.Wider Implications: In sterilized women who suffer regret, surgical tubal re-anastomosis is an effective treatment, especially in younger women. However, there is a need for randomized controlled trials comparing the success rates and costs of surgical reversal with IVF. [ABSTRACT FROM AUTHOR]

Antecedentes: Los avances en las técnicas de cirugía laparoscopia han permitido a cirujanos entrenados realizar reanastomosis tubaria bilateral por laparoscopia, reportando resultados similares a los de la técnica vía laparotómica. Objetivo: Evaluar una nueva técnica de reanastomosis tubaria llamada "técnica de tres puntos". Método: Se realiza estudio retrospectivo que evalúa 5 casos de pacientes con antecedentes de esterilización quirúrgica, a quienes se les realizó reanastomosis tubaria laparoscópica con la técnica de tres puntos. Resultados: La edad promedio de las pacientes fue de 35,8 ± 5,7 años (rango: 26-40 años); 80% (8/10) de las trompas fueron reanastomosadas. En dos pacientes la reanastomosis fue unilateral por segmento distal ausente de la trompa contralateral. El tiempo promedio de duración de la cirugía fue de 150 ± 7,9 minutos (rango: 140-160 minutos). La tasa de embarazo fue de 40% (2/5). Los embarazos se produjeron en las pacientes más jóvenes y con reanastomosis bilateral. En aquellas que no lograron embarazo se realizó histerosalpingografía verificándose el 100% de las trompas reanastomosadas permeables.Background: Advances in endoscopio surgical techniques have allowed well-trained and skilled surgeons to perform tubal anastomosis by laparoscopy reporting similar results than by laparotomy. Objective: To evalúate a new technique we called "three-stitch method". Method: The outcomes for this evaluation were tubal patency and pregnancy rate. A retrospective analysis of five cases of previous tubal sterilization underwent endoscopio tubal reanastomosis using the "three-stitch technique" was done. In all patients a preoperative hysterosalpingogram was performed to confirm occlusion. Results: The average age was 35.8 ± 5.7 years (rango: 26-40 years). All the patients underwent previous tubal sterilization (four cases using Pomeroy technique and one case with Yoon Ring). Eighty percent (8/10) of tubes were reanastomosed. In two cases, due to inadequate conditions of distal or proximal ends of one tube, surgery was performed on the other only. The average surgical time was 150 ± 7.9 minutes (range 140-160 minutes). The pregnancy rate was 40% (2/5). Pregnancy was achieved in younger patients who underwent bilateral reanastomosis. In those patients where pregnancy was not accomplished, a hysterosalpingography was taken to evalúate tubal patency. All of the reanastomosed tubes showed tubal patency at six months follow-up.

Antecedentes: La esterilización tubárica se realiza en un número importante de pacientes jóvenes que por diferentes motivos desean posteriormente un nuevo embarazo, porcentaje que varía entre el 1,3-15%. Hasta ahora la cirugía ha sido la primera alternativa de tratamiento y gracias a la evolución de la técnica y el desarrollo de material quirúrgico, es posible de realizar por vía laparoscópica. Objetivos: Hacer una síntesis de la historia y técnicas utilizadas en la reanastomosis tubárica, los criterios de selección, el estudio preoperatorio, los factores pronósticos y comparar los resultados de la laparotomía y la laparoscopia. Métodos: Se realiza búsqueda en base de datos Medline PubMed usando las palabras clave: tubal anastomosis, reversal of esterilization, infertility, microsurgery, tubal esterilization; se seleccionan todas aquellas publicaciones tipo review de reanastomosis tubárica con microcirugía abierta y todas aquellas de reanastomosis por vía laparoscópica. Resultados: La reanastomosis tubárica por laparotomía con técnica microquirúrgica tiene un éxito entre 60 y 90% de tasas de embarazo. Las primeras publicaciones de la técnica laparoscópica no presentan resultados satisfactorios, sin embargo casuísticas más numerosas y especialmente las que muestran la técnica microlaparoscópica tienen resultados similares con todas las ventajas de la laparoscopia. Conclusión: La recanalización tubaria por vía laparoscopica es una técnica factible, probada y exitosa, alternativa a la laparotomía, sin embargo, para su implementación con resultados satisfactorios es necesario contar con equipamiento apropiado, experiencia previa en cirugía abierta y entrenamiento en cirugía endoscópicaBackground: Tubal ligation is used in a large number of young patients, who frequently want a new pregnancy, the percentage rate ranges from 1.3 to 15%. Until now the standard treatment has been the microsurgical tubal anastomosis through laparotomy, however, the development of new techniques and instruments allowed a laparoscopic approach for this surgery. Objectives: to make a synthesis of the hystory and operatory technics in laparoscopic tubal anastomosis to evaluate the inclusions criteria, the preoperative work-up, the factors of prognosis and to make a comparison between laparotomy and laparoscopy. Methods: We make a search in medline database (PubMed), with the key words: tubal anastomosis, reversal of sterilization, infertility, microsurgery, tubal sterilization, and selecting all of the review publications in microsurgical tubal reanastomosis by laparotomy and all of publications of the laparoscopic technic. Results: The microsurgical tubal anastomosis through laparotomy has a pregnancy rate ranging from 70% to 80%. The first publications whith the laparoscopic technic show dissapointed results, however, papers with bigger casuistics and with the microlaparoscopic technic show the same results that the open technic with all of the advantages of the laparoscopy. Conclusion: Laparoscopic tubal reversal is a feasible, tested and successful alternative to the traditional surgery performed by laparotomy, however, to achieve a successful outcome it is necessary a meticulous surgical technique, adequate equipment and extensive experience with tubal anastomosis by laparotomy and advances laparoscopic techniques

Os autores descrevem sua experiência em recanalização tubária videolaparoscópica pós-laqueadura em 10 pacientes, tratadas no período de junho de 1994 a fevereiro de 1996. A duração da 1ª cirurgia foi de 4 horas e 30 minutos e da última foi de 2 horas e 30 minutos. A metade das recanalizações foi ístmo-ístmica. O tamanho mínimo das tubas restantes foi de 4 cm de cada lado e os fios utilizados para a sutura foram o 7-0 e 6-0 monofilamentares, derivados do ácido poliglicólico. A permeabilidade tubária foi verificada pela histerossalpingografia 3 meses após a cirurgia e, como resultado, 88, 8% das tubas operadas estavam permeáveis. Quatro das pacientes consideradas aptas para engravidar ficaram grávidas durante o período de seguimento. O tempo médio de permanência hospitalar foi de 24 horas. Não houve complicações cirúrgicas ou anestésicas.The authors describe their experience with videolaparoscopic tubal anastomosis in 10 selected patients operated from June 1994 to February 1996. The time of the first surgery was 4 hours and 30 minutes and the last , 2 hours and 30 minutes. The time was different according to the change of auxiliary team. Half of the reanastomoses were isthmic- isthmic. The minimum size of the remaining tubes was 5cm on each side. We used 7-0 and 6-0 polyglycolic acid monofilament for suture. The tube patency was tested by hysterosalpingogram 3 months after surgery, and it was shown that 88.8% of the operated tubes were free. The patients considered able to become pregnant were followed up for a short period of time and 4 of them became pregnant. The hospitalization lasted 24 hours and there were no surgical or anesthetic complications.

To determine the interest of using robotic laparoscopic surgery in the management of female infertility, we reviewed our own activity and searched the Medline database for publications on robotic technology in infertility surgery, with the use of the following search words: robotic laparoscopy, tubal anastomosis, myomectomy, deep infiltrating endometriosis, and adnexal surgery. Robot-assisted laparoscopic surgery has seen rapid progression over the past few years. It has been mostly used for myomectomy, proximal tubal reanastomosis, and deep endometriosis surgery. Despite its increased range of indications, no randomized control studies are available. The place of robotic surgery in the management of infertility remains undetermined. [ABSTRACT FROM AUTHOR]

Abstract: We report two cases of robot-assisted coelioscopic proximal tubal reanastomosis after proximal tubal ligature. Patients were aged 43 and 34 years respectively and had previously undergone proximal tubal ligation by coagulation section at 37 years of age for the first patient, and by Filshie clip at 24 years for the second one. Both had regular menstrual cycles and their ovarian reserve was good. Their partners were presenting with normal sperm criteria. Proximal tubal reanastomosis was carried out in September 2010 by robotic coelioscopy with five extramucous vicryl 5-0 stitches on each tube and positive blue testing. Total durations of the interventions were 200 and 220minutes respectively. Postoperative outcomes were simple and patients had spontaneous pregnancy at 4 and 2.5 months respectively. Both pregnancies show normal progress currently. This is a contribution to literature data meant to determine the role of robotics in proximal tubal reanastomosis. [Copyright &y& Elsevier]

Modified laparoscopic microsurgical tubal anastomosis is an alternative for microsurgical anastomosis via laparotomy to reverse sterilization in women with renewed child wish. The current study aims to evaluate the fertility outcome after modified laparoscopic microsurgical tubal anastomosis. A retrospective study was performed. Fifty-eight women who underwent modified laparoscopic microsurgical tubal anastomosis were monitored to investigate the fertility outcome and characteristics of this new technology. Of the 58 patients, the cumulative pregnancy rate (PR) in the 42 patients with follow-up data was 23.8% (10/42), 57.1% (24/42), 66.7% (28/42), and 73.8% (31/42) within 6, 12, 24, and 36 months after surgery, respectively. The intrauterine PR was 69.0% (29/42). Two patients (4.8%) had ectopic pregnancies that occurred within 24 months of surgery; three cases ended in spontaneous abortion. The delivery rate was 83.9% (26/31). The length of operating time was 1.2±0.3 h, with a range of 1.0-2.5 h (60-145 min), and the mean time was approximately 75 min. The blood loss was relatively small, between 10 and 50 ml with an average amount of 22 ml. Thus, the modified laparoscopic tubal anastomosis is a highly successful procedure and a viable alternative to open abdominal microsurgical approaches. Compared with the traditional laparoscopic tubal sterilization reversal, this modified approach has three advantages: (1) less invasive approach via a trocar reduction; (2) remodeling of tube is better performing tied together after 3-4 sutures; and (3) faster operating time. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate various techniques for restoring tubal patency after sterilisation. Methods: A search strategy was designed, and for each subject either thesaurus terms (MeSH descriptors) or terms from the title or summary were used. Results: Mean length of hospital stay following laparoscopy seems to be shorter in comparison with laparotomy (3.3 vs. 6.1 days, P < 0.05). Rate of conversion to laparotomy is 5%. Pregnancy rates observed are between 54 and 88% for laparotomy and 31-85% for laparoscopy. Mean time to conception was between 2 and 9.6 months. Most pregnancies occurred in the 2 years following restoration of tubal patency (cumulative conception rate 80% at 12 months). Young age (<35 years), type of ligature (rings), how recently the ligature was done (<8 years), the anastomosis site (in the middle of the tube) and a good length of remaining tube (>7 cm) are the factors that govern whether there can be good restoration of tubal patency. Ectopic pregnancy rates observed are between 1.7 and 12% for laparotomy and 0-7% for laparoscopy. There are no randomised or quasi-randomised studies comparing tubal anastomosis and in vitro fertilization. Conclusions: There are few good-quality controlled studies in this area. Results of restoration of tubal patency seem to be comparable, regardless of the route of approach (laparotomy or laparoscopy). [ABSTRACT FROM AUTHOR]

Objective: To evaluate the pregnancy and delivery outcome of robot-assisted tubal reanastomosis. Design: Retrospective cohort study. Setting: University hospital. Patient(s): Ninety-seven patients with available follow-up who underwent the reversal of tubal ligation, with a median age of 37 years (range, 24–47 years). Intervention(s): Tubal reanastomosis by robot-assisted laparoscopy. Main Outcome Measure(s): Analysis of the distribution of time to conception and to estimate the crude pregnancy and birth rates at 2 years. Result(s): The overall pregnancy and birth rates were 71%, (95% confidence interval [CI], 61%–80%) and 62% (95% CI, 52%–72%). Ninety-one percent (95% CI, 76%–98%) of patients <35 years old became pregnant, and 88% (95% CI, 72%–97%) delivered at least once. The corresponding pregnancy and delivery rates were 75% (95% CI, 57%–89%) and 66% (95% CI, 47%–81%) between 36 and 39 years old, 50% (95% CI, 25%–75%) and 43.8% (95% CI, 20%–70%) between 40 and 42 years old, 33% (95% CI, 10%–65%) and 8.3% (95% CI, <1%–38%) after the age of 43 years. Conclusion(s): This study reports satisfactory birth rates after tubal reanastomosis by robot-assisted laparoscopy in patients aged 40 years or less. [ABSTRACT FROM AUTHOR]

Objective: To evaluate pregnancy rates after tubal microsurgical anastomosis.Design: Retrospective study.Setting: Private tertiary care center.Patient(s): Two hundred sixty-one women undergoing tubal microsurgical anastomosis.Intervention(s): Tubal anastomoses were performed by minilaparotomy using microsurgical principles and approximating proximal and distal tubal ends in a two-layer technique with 8-0 ethylon.Main Outcome Measure(s): Pregnancy outcome was analyzed for the technique of sterilization, location of anastomosis, tubal length, age, and semen parameters.Result(s): After exclusion of 89 patients lost to follow-up (34%) and 8 who did not attempt to conceive, 164 of the 261 patients were analyzed.The overall intrauterine pregnancy rate was 72.5%, with a miscarriage rate of 18% and a tubal pregnancy rate of 7.7%. Related to age, the cumulative intrauterine pregnancy rate was, respectively, 81%, 67%, 50%, and 12.5% for patients <36, 36-40, 40-43, and >43 years. Mean time to pregnancy was respectively 6.9, 6.2, and 12.7 months, respectively, for patients aged <36, 36-39, and 40-43 years According to the type of sterilization, intrauterine pregnancies occurred in 72% after ring sterilization, 78% after clip sterilization, 68% after coagulation, and 67% after Pomeroy sterilization. Intrauterine pregnancies and ectopic pregnancies, respectively, occurred in 80% and 3.4% in the isthmo-isthmic, 63% and 18% in the isthmo-ampullar, 75% and 8.3% in the isthmo-cornual, 100% and 0% in the ampullo-ampullar, and 60% and 0% in the ampullo-cornual anastomosis groups. Tubal length after anastomosis did not influence the pregnancy rate. In case of fertile sperm, the pregnancy rate was found to be 80%, and it decreased to 50% in case of subfertile semen.Conclusion(s): Our results clearly demonstrate the validity of tubal microsurgical anastomosis, establishing a quasinormalization of the fertility potential and offering the opportunity for a spontaneous conception. [ABSTRACT FROM AUTHOR]

The article presents the surgical procedures for the correction of fallopian tube occlusions or defects. Procedures assisting in pregnancy is also presented. It notes the procedures like tubal catheterization which uses the mechanism of direct injection of radio-contrast materials into the cornua of the tube to dissolve the mucus plugs, tubal anastamosis, and tubocornual anastamosis. It concludes the effectivity of assisted reproductive technologies and on the increased chances of pregnancy.

Objective: To evaluate the feasibility of robotic microsurgical tubal anastomosis and compare the results and cost effectiveness with the same procedure performed by laparotomy. Design: Prospective cohort study. Setting: University hospital. Patient(s): Patients with a history of bilateral tubal ligation who desired reversal for future fertility. Intervention(s): Tubal anastomoses through either a robotic approach or through a laparotomy. Main Outcome Measure(s): Operative times, hospitalization, complications, postoperative patency, clinical outcomes, and the cost per live birth. Result(s): The mean operative time for robotic anastomoses was statistically significantly greater than open anastomoses (ROBOT 201 minutes; OPEN 155.3 minutes), although hospitalization times were statistically significantly shorter (ROBOT 4 hours; OPEN 34.7 hours). The return to instrumental activities of daily living was accelerated in the patients who had undergone a robotic anastomosis (ROBOT 11.1 days; OPEN 28.1 days). Although this was a small series, the pregnancy rates were comparable between groups (ROBOT 62.5%; OPEN 50%), yet the rate of abnormal pregnancy was higher in the robotic group (ectopic: ROBOT 4, OPEN 1; spontaneous pregnancy loss: ROBOT 2, OPEN 1). The cost per delivery was similar between the groups (ROBOT $92,488.00, OPEN $92,205.90). Conclusion(s): Robotically assisted laparoscopic microsurgical tubal anastomosis is feasible and cost effective with results that are comparable with the traditional open approach. [Copyright &y& Elsevier]

Copyright of Revista Chilena de Obstetricia y Ginecología is the property of Revista Chilena de Obstetricia y Ginecologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Two treatment options are available to women who wish to become pregnant after having had tubal sterilization: microsurgical reversal or IVF. The first approach is designed to restore tubal function, whereas the second replaces it. The first, to be successful, requires the presence of sufficient tubal length and normal or treatable fertility parameters. Treatment should therefore be individualized, based upon the findings of the couple's investigation, their wishes and the costs involved. The age of the female is the most important factor that affects the outcome with both treatment options. The live birth rate per cycle with IVF is 28%, but only 65.8% are singletons; 31.0% are twins and 3.2% triplets or more. Microsurgical tubal anastomosis yields a birth rate that exceeds 55%, without increased risk of multiple pregnancy. It offers the couple multiple cycles in which to achieve conception naturally, and the opportunity to have more than one pregnancy from a single intervention. The real dilemma lies with the 'industrialization' of IVF, and its frequent use as primary treatment for infertility. The dilemma is heightened by the fact that reconstructive tubal microsurgery is being taught and practised less and less, thereby eliminating this credible surgical option in most centres. [ABSTRACT FROM AUTHOR]

Abstract: Objective: We sought to identify the characteristics of women in a military population who are likely to seek a tubal anastomosis after a previous bilateral tubal ligation (BTL). Method: A written investigational review board-approved questionnaire was administered to 56 women, ages 18–40 years, requesting evaluation for a reversal of a prior BTL and 52 women of the same age range not seeking reversal. The questionnaire identified demographics and relationship characteristics of volunteers at the time of their decision to have a BTL and at the present time. Results: Age 25 years or younger, sterilization due to pressure from a partner, poor marital relationship at the time of the BTL and a new marriage are highly predictive of tubal sterilization regret and a request for sterilization reversal in a military population. In addition, women requesting a tubal anastomosis reported less preoperative counseling on the permanence of a BTL and of the male alternative for permanent female sterilization, vasectomy. Conclusion: Women with these characteristics should have extensive counseling before undergoing tubal sterilization. [Copyright &y& Elsevier]

Copyright of Revista Chilena de Obstetricia y Ginecología is the property of Revista Chilena de Obstetricia y Ginecologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: To evaluate the pregnancy outcome after laparoscopic tubal anastomosis. Methods: From December 1998 to December 2001, 26 patients with bilateral tubal ligation who underwent laparoscopic tubal anastomosis were prospectively evaluated. Patients’ age varied from 28 to 37 years. Results: Laparoscopic tubal reversal was performed in 23 patients. Bilateral reversal was possible in all but two patients. The operation time ranged from 95 to 155 min and all patients were discharged in the following morning after surgery. After 3 months, tubal patency was confirmed in 15 patients (15/23). Pregnancy rate was 56.5% (13/23), without ectopic pregnancies. The average time from tubal reversal and pregnancy was 6 months. Conclusions: In selected cases, laparoscopic tubal reversal can be offered to patients who had been submitted to tubal sterilization and desire new pregnancies. Patient selection as well as meticulous surgical technique are key factors in achieving satisfactory pregnancy rates. [Copyright &y& Elsevier]

: ObjectiveTo report an unusual complication associated with the use of a long-term intrafallopian stent during microsurgical tubal anastomosis.: DesignCase report.: SettingTertiary academic center.: Patient(s)A 36-year-old woman in whom an intrafallopian stent used during a sterilization reversal procedure could not be transcervically retrieved in the office.: Intervention(s)Hysteroscopic evaluation for removal of intrafallopian stent, followed by operative laparoscopy for postoperative abdominal pain.: Main outcome measure(s)Patient symptoms, potential for morbidity, and review of the literature.: Result(s)Hysteroscopic view of the uterine cavity failed to identify the intrafallopian stent. Laporoscopic evaluation of postoperative abdominal pain revealed significant formation of pelvic and abdominal adhesions. The 2-0 nylon suture used as an intrafallopian stent was seen sitting freely on top of the liver serosa. Adhesiolysis and successful retrieval of the stent resolved the patient’s symptoms.: Conclusion(s)To our knowledge, this is the first report describing complete dislodgment and cephalad migration of an intrafallopian stent. Patient morbidity and health care costs may increase when long-term stents are used for sterilization reversal. [Copyright &y& Elsevier]

Fallopian tube interruption is a common form of contraception worldwide. For a variety of reasons (e.g. change in marital status, wish for additional children, psychological factors), many of these women seek restoration of fertility. Laparoscopic tubal anastomosis is one of the newest of these procedures by which this can be achieved. Sixteen women underwent laparoscopic microsurgical anastomosis. We used a three-stitches technique with tubal cannulation adapted from methods described in the literature. Five pregnancies occurred, giving an overall pregnancy rate of 31.2%. Surgical outcome depends on the patient's age, the method of tube interruption and the length of Fallopian tube segments being anastomosed. In this study, the feasibility of laparoscopic tubal sterilization reversal is confirmed, as well as the benefits offered by laparoscopic procedures in terms of quality of life. Further improvement of surgical outcome will be achieved not only through better laparoscopic techniques but also through careful screening for surgical indications. [ABSTRACT FROM PUBLISHER]

Laparoscopic rescue after tubal anastomosis failure is reported for the first time. The patient was a 33 year old woman sterilized by Pomeroy's method. Restoration of fertility was achieved by mini-laparotomy with isthmo—isthmic end-to-end anastomosis of bilateral tubes. Unfortunately, the patient did not become pregnant and tubal occlusion was diagnosed 6 months later by hysterosalpingography. Laparoscopic rescue with repeat isthmic—ampullary anastomosis and adhesiolysis was performed. Post-operatively, the patient had one menstruation and then achieved an intrauterine pregnancy. Instead of in-vitro fertilization/embryo transfer, laparoscopic rescue may be an alternative option for the patient with failed anastomosis. [ABSTRACT FROM PUBLISHER]

Fertility outcome following sterilization reversal by laparotomy was evaluated. We studied all sterilization reversals performed between January 1978 and December 1991; a total of 226 women were treated. Tubal anastomosis was performed according to the rules for microsurgery. The microsurgical technique comprised two main phases: preparation of the healthy tube segments and the anastomosis carried out on two layers. It was possible to study the subsequent fertility of 206 patients in all, as 20 patients were lost to follow-up (8.8%). Cumulative pregnancy rates were evaluated by life-table analysis. The overall intrauterine pregnancy rate, including births and miscarriages, was 69.9% (144 patients) after 2 years. The cumulative intrauterine pregnancy rate was 62% at 18 months. Analysis of the fertility results demonstrated that age was the most significant predictive factor. The cumulative intrauterine pregnancy rate at 2 years was 83.5% (61 cases) for patients ≤33 years, 70% (35 cases) for patients aged 34–36 years, 62.5% (30 cases) for patients aged 37–39 years, and 51.4% (18 cases) for patients aged ≥ 40 years. Even for patients aged ∼40 years, microsurgical repermeabilization can be retained as the first choice rather than in-vitro fertilization. [ABSTRACT FROM PUBLISHER]

We report a new laparoscopic technique of tubal anastomosis: the laparoscopic one stitch technique. After preparation and approximation of the two tubal segments, the anastomosis consists of one single suture placed at the ‘12 o'clock‘ site of the antimesenteric borders. Four patients have undergone this procedure. Bilateral tubal patency was confirmed in three cases. Hysterosalpingography was not performed on the fourth patient as she was already 1 month pregnant after tubal anastomosis. [ABSTRACT FROM PUBLISHER]