Laparoscopic tubal anastomosis: reversal of sterilization

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Abstract
A case of laparoscopic reversal of tubal sterilization is reported. The patient was a 38 year old woman sterilized by bipolar diathermia two years earlier. Refertilization was performed by laparoscopic end to end anastomosis of one tube. Postoperatively, the patient had one menstruation and then achieved an intrauterine pregnancy. The laparoscopic method of refertilization saves expensive hospitalization costs.A 38-year-old woman, who had a normal delivery at age 29 and a Cesarean section at age 35, underwent laparoscopic adhesiolysis the next year because of pain. Later that year, a laparotomy was performed to remove the left adnex because of a hemorrhagic corpus luteum. During this operation, she underwent sterilization by bipolar coagulation and division of the right tube. 6 months later, her 2-year-old daughter died of hemophilus meningitis. The next year, she was admitted to the hospital several times because of pain in her lower abdomen. She decided to undergo refertilization. The operative technique involved insertion of a Foley catheter into the uterine cavity. Laparoscopic adhesiolysis was performed, and blue dye was flushed through the catheter. The medial end of the right tube was cut off in thin slices until dye passed through the lumen. The lateral part of the tube was then cut, and hemostasis was secured by point monopolar diathermia. The portions of the tube were mobilized slightly and adapted by 2 sutures in the muscularis and 1 in the serosa. Blue dye was flushed through the tube to demonstrate patency. The pelvic cavity was rinsed with Ringer's solution, with about 300 ml left in the abdomen. No antibiotics or steroids were administered. The operation took 90 minutes, and the patient left the hospital the next day. She was able to return to work without using any sick leave. 22 days after the operation, she had a normal menstruation and she achieved an intrauterine pregnancy in the following cycle. A lack of funds in the Norwegian public health service has led to a debate about the necessity of providing the so-called "luxury" procedures of refertilization and infertility surgery. The traditional operative methods are expensive and require between 5 and 7 days of hospitalization. In order to determine whether traditional laparotomy with microsurgical end-to-end anastomosis of the tube or laparoscopic refertilization is more effective, a comparative, randomized study will be necessary.