REVERSAL OF TUBAL STERILIZATION

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Abstract
Due to the facts that sterilization techniques are now available which greatly restrict the length of tubal damage while losing little in efficiency and that numerically requests for reversal are now greater per 1000 than spontaneous failure rates, potential reversibility must be considered when sterilization techniques are being compared. Preoperative assessment should be carried out since detailed information regarding the type of sterilization originally performed is often lacking. Laparoscopy is a simple procedure with minimal morbidity. It provides information about the length of tubes, the presence of adhesions and the normality of the fimbria, and all have an important bearing on prognosis and whether the patient may or may not elect to proceed with the reversal surgery. Most of the surgical procedures now performed attempt to anastomose the medial and lateral stumbs of the tube. Prior to 1974 tubal reconstruction was performed without magnification and often with rather crude instruments and techniques. During 1974 the 1st reports were published of microsurgery applied to the field of animal Fallopian tube reconstruction, and many reports have subsequently appeared in which pregnancy rates of greater than 60% were achieved in women with these techniques. When compared with naked eye surgery, microsurgery offers several advantages: it allows the careful visualization of the cut tubal ends prior to anastomosis; and it allows more precise placement of sutures.

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