Microsurgical Tubal Sterilization Reversal

Tubal sterilization is one of the more common means of birth control used in the United States. Since it is a permanent form of contraception, women who have had tubal sterilization will have to undergo another surgical procedure if they decide to have children. 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 microsutures 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 injuries

Drs. Hummel and Kettel use an operating microscope or another magnifying source to adequately visualize the tubal anatomy; 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 a small incision, and takes little time (15 to 30 minutes).

Reversal of tubal sterilization can be performed through a minilaparotomy incision; however, because of the length of operating time, patients usually need to spend one to two days in the hospital to recover. Minilaparotomy patients must refrain 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, and use stairs, and have no dietary restrictions.

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 two to three 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.

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 the tube) a similar procedure is done on the end of the tube that reaches to the ovary (distal portion of the tube). The chance for an egg and sperm to get together is thus restored. Once we know that both ends of the tube are re opened we can begin the process of sewing them together.

The open sections of tube are brought together and several very tiny sutures are used to connect the muscular portion of the tubes. 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 on an imaginary clock face. The sutures all are placed before any of them are tied.

This delicate portion of the procedure is done under magnification using a suture thinner than a human hair. In order to place these sutures, the physician and an assistant look through high-power lenses 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 layers of the tubal ends are brought together.

Step 3:

Once the inner layers of the tubes are brought together, attention is given to the outer layers (serosa). 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 ensures excellent healing and minimizes adhesion formation on the tubes. Throughout the operation, all the tissues are kept moist with a surgical solution to prevent the tissue from desiccation. The outer layer is put together with many tiny stitches to keep the site of reversal (anastomosis) water tight and smooth (Figure 3). After this layer is closed, the reversal is complete. These steps must then be repeated on the other side. Most of the time, it takes 45 minutes to one hour to reverse the left tube and the same amount of time to reverse the right tube.

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 positions within the pelvis and the area around them cleansed several times with another surgical solution. The surgeons then carefully close the incision and you taken to the recovery room.

Tubal Reversal FAQ's

After the tubal reversal you will remain in the recovery room for approximately one hour. After this, you have a choice. Most patients choose 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.

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. By the next day you no longer need someone to stay with you, but you will feel like resting in bed for the next two to three days. You will gradually increase your activity over the next few weeks. Many patients are functioning fairly well after two weeks, but some will take a little longer. In our experience it is very rare to need more than four 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 checkup where we will examine you and your incision to make sure that all has gone well.

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 six 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.

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 the separate components in one fee.

Comprehensive Costs $8,140.00*

*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, assistant surgeons, operating room time, operating room supplies, medications given during the operation, and one hour of recovery. If you choose to stay in an extended care facility, this is also additional.