ABSTRACT
Tubal sterilization techniques that spare the fimbriae and cause the least amount of tubal destruction offer the best chance for reversal of sterilization. Patients seeking reversal of sterilization should be carefully selected. Surgical technique and equipment are important factors in reversal procedures; microsurgical techniques are shown to be more effective than macroscopic techniques.
PIP: Microsurgical techniques enables successful results in tubal anastomosis for reversal of sterilization. Patients in the study had all been sterilized at the medial isthmic segment. Ideally, in this case, there was no luminal disparity and a relatively thick circular muscle coat. After the pathologic or fibrotic tissue had been removed, a series of 8/0 nylon stitches, which include only the muscular coat, was carried out under microscopy. 6 or 7 stitches usually are sufficient to make a watertight anastomosis. A 2nd layer of 8/0 nylon stitches was used to repair the gap in the mesentery and the serosa overlying the fallopian tube. The patency of the anastomosis was inspected at 1 year from the date of the procedure by celiochromoscopy. The good results obtained are the result of the careful techniques of reconstruction using microscopy and the right instrumentation. In all cases, it is most important to consider the site of sterilization. The isthmo-isthmic site is regarded as the most ideal for microsurgical reversal because it is the easiest site for an anastomosis. Silber maintains that the prospect for a normal pregnancy, after reversal, is directly proportional to the length of the remaining tube which is the only critical factor, as long as there is at least 1 cm of ampulla. The time interval that passes between sterilization and surgical reversals also needs to be considered as an influencing factor in terms of the successful results of the tubal reconstruction.
