Tubal Reversal
SDFC Tubal Sterilization Reversal Treatment Program
Tubal sterilization is one of the more common means of birth control used in the United States. Since it is a permanent form contraception you have to undergo another surgical procedure if you decide to have kids. Drs. Hummel and Kettel offer the operative procedure, which is known as a reversal of tubal sterilization or microsurgical tubal reanastomosis.
Whereas the sterilization involved simply tying, clipping, banding, or burning of the fallopian tubes, the reversal procedure employs the use of very thin microsuture to carefully put the tubes back together. In many respects, the operation is very similar to the delicate repair of small blood vessels and/or nerves that plastic surgeons perform in cases of hand injury.
Drs. Hummel and Kettel use an operating microscope or another magnifying source to adequately visualize the tubal anatomy, and this makes for a tedious surgery that may take from one to two hours to perform. Tubal sterilization is frequently performed through the laparoscope or small incision, and takes little time (15 - 30 minutes).
Reversal of tubal sterilization can be performed through a minilaparotomy incision, however, due to the length of operating time, patients usually need to spend one to two days in the hospital to recover. Minilaparotomy patients must be restricted from lifting and exercising for two weeks after surgery and usually require pain medication after tubal reanastomosis. After leaving the hospital, patients are allowed to drive, walk, use stairs, and have no dietary restrictions.
SDFC Microsurgical Tubal Reversal Treatment Program
Tubal Reversal Procedure
Once you are comfortably asleep in the operating room, a small incision is made in the lower abdomen along the "bikini line." The incision is little more than 2-3 inches and is smaller than the incision used for a C-Section. The surgeons work down to the uterus and fallopian tubes and then begin the procedure. This procedure is delicate and requires great magnification. The skill, knowledge and training of the surgeon are very important to the overall success of this operation.
Step 1:
The fallopian tubes are inspected and measured to make sure that there is enough tube available to complete the reversal. The scarred portion of tube that has been previously cut, tied, clipped or burned is then removed to expose a fresh, new, open section of tube. A dilute solution of blue colored fluid is then injected through the vagina and into the cervix to make sure there is an open pathway from the vagina to the tube. Once this end of the tube is open (proximal portion of tube) a similar procedure is done on the end of the tube that reaches to the ovary (distal portion of tube). The chance for an egg and sperm to get together is restored! Once we know that both ends of the tube are re-opened we can begin the process of sewing them together.
Step 2:
The open sections of tube are brought together and several very tiny sutures are used to connect the muscular portion of the tubes together. The sutures are placed around each end of the open tube at 12 o'clock, 3 o'clock, 6 o'clock and 9 o'clock in an imaginary clock face. The sutures are all placed before any of them are tied.
This delicate portion of the procedure is done under magnification using a suture (thread) thinner than a human hair!! In order to place these sutures the physician and his assistant look through high-power lens that magnify the ends of the tubes so that the sutures are placed accurately and perfectly align the ends together. Once all the sutures are perfectly placed they are tied one by one until the inner layer of the tubal ends are brought together.
Step 3:
Once the inner layer of the tubes is brought together, attention to the outer layer (serosa) is given. The strength of the reversal is predominantly in the muscular inner layer, but the outer layer is also important. Accurate reapproximation of the serosal layer insures excellent healing and minimizes adhesion formation to the tubes. Throughout the operation all of the tissues are kept moist with a surgical solution to prevent the tissue from drying or desiccation.
The outer layer is put together with many tiny, tiny stitches to kept the site of reversal (anastomosis) water tight and smooth (Figure 3). After this layer is closed the reversal is complete. Believe it of not these steps must then be repeated on the other side!! Most of the time, it takes 45 min to 1 hour to reverse the left tube and the same amount of time to reverse the right tube.
Step 4:
The final step in the tubal reversal operation is to make sure that the tubes are both completely open and back to normal!! This is done by injecting more blue-colored fluid through the cervix, uterus and tubes. The blue fluid should fill each tube and spill out the end next to the ovary. Once this is seen, the uterus and tubes are gently replaced in their normal position within the pelvis and the area around them cleansed several times with another surgical solution. The surgeons then carefully close the incision and you are taken to the recovery room to awaken.
How long is the recovery from tubal reversal?
After the tubal reversal you will remain in the recovery room for approximately 1 hour. After this you have a choice. Most patients chose to go home, but some prefer to spend the first night in the comfort of an extended care facility much like a hospital, but cozier and not as sterile.
There are nurses who will watch over you through the night and you can go home the next morning. Because this does add some cost, you may choose to go home. When you arrive home on the day of surgery, you will need someone with you at all times. It is NOT okay for your husband to drop you off at home and return to work. By the next day your husband can go to work, but you will feel like resting in bed for the next 2-3 days. You will gradually increase your activity over the next few weeks. Many patients are functioning fairly well after 2 weeks, but some will take a little longer. In our experience it is very rare to need more than 4 weeks before returning to work and your usual activities.
You will likely feel abdominal soreness and pain for the first few days after surgery. You will be given pain medications to keep you comfortable. You can eat and drink normally the day after surgery and we will actively encourage you to be up and around the day after the operation. Two weeks after the operation you will be scheduled for a post-operative check-up where we will examine you and your incision to make sure that all has gone well.
When can we try to get pregnant after a tubal reversal?
As soon as you feel up to it you can try to conceive. The tubes should function immediately after surgery and lots of women have successfully become pregnant the first cycle after tubal reversal. Don't be discouraged if this doesn't happen. We would like you to try for 6 months after the operation before meeting with Dr. Kettel or Dr. Hummel. If you haven't conceived within six months we will check out the tubes to make sure they are still open and then suggest some strategies to help things along. Relax! The vast majority of women who have this procedure done get pregnant quickly and without additional treatment.
How much does tubal reversal cost?
The San Diego Fertility Center has worked hard to control the costs of this operation. In many institutions the costs of tubal reversal can easily exceed $10,000!! By opening our own fully licensed and accredited surgical center, the Del Mar Surgery Center, we can now control all the individual components of the procedure and offer a comprehensive package price that includes all of the separate components in one fee.
San Diego Fertility Center Pricing for Microsurgical Tubal Reversal
Comprehensive Costs $8000.00*
*This does not include some costs: Initial consultation, semen analysis and pre-op blood tests are extra. It does include the costs of the anesthesiologist, surgeon’s fee, assistant surgeons fee, operating room time, operating room supplies, medications given in the operation and one hour of recovery. If you chose to stay in an extended care facility, this is also additional.
Last updated:
January 25, 2006
Authors: Dr. William Hummel and Dr. Michael Kettel