Advanced Gynaecological Surgery Centre
 
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Reversal After Sterilisation

Background

Many women undergo tubal ligation as a reliable form of contraception. For many reasons with time some women will choose to have the operation reversed. Until recently that has required open surgery.

In more recent years the procedure can be performed using laparoscopic techniques. This means that women requesting a reversal of sterilization can enjoy the benefits of “key hole” surgery including less pain and a faster return to normal activity.

The Procedure

  • The operation (laparoscopy) involves 5 small cuts in the abdomen.
  • The tubes are inspected to make sure they are suitable for rejoining.
  • The ligating clips are removed and the tubes are cleanly transected to expose fresh edges.
  • The first part of the tube is checked for patency using a blue dye.
  • The ends are then stitched together using 4-5 very fine stitches. 
  • Patients can go home that day but quite often stay overnight.

Success rates

  • Dependent on multiple factors including
    • age
    • fertility status
    • pelvic adhesions and the
    • length of fallopian tube available for reanastomosis (rejoining).
  • Overall pregnancy rates of around 50% have been quoted.
  • The success rate is very similar to IVF  so for those women wanting only one pregnancy IVF may be a better option.
  • Women in their forties who are ovulating may actually do better with tubal reversalas the success rate of IVF falls in relation to the woman’s age. 
  • Prior to any surgery your Doctor will discuss the success rates of surgery and the option of IVF.

Risks

The risks of Laparoscopic Surgery will depend on many issues including the physical state of the patient and any concurrent pelvic pathology. Overall major complications occur in less then 1% of patients.

During the operation major complications include:

  • Injury to internal organs – e.g. bowel / ureter or bladder.
  • Haemorrhage requiring a blood transfusion.
  • Gas embolism. The carbon dioxide gas used to distend the abdomen may, rarely, pass into the large blood vessels up to the lungs, causing problems with the lungs and heart.

After the operation problems include:

  • Wound, pelvic, bladder or chest infection
  • Pelvic or wound haematoma (collection of blood )
  • DVT – deep vein thrombosis (blood clot in the leg veins).
  • Pulmonary embolus (blood clot in the lungs) – rare but serious.
  • Abnormal wound healing / scar formations (keloid).
  • Constipation (very common)
  • Shoulder pain/discomfort

Following successful tubal surgery

  • There is a risk that a pregnancy can become stuck in the tube and grow there.
  • This is known as an ectopic pregnancy and can occur in women with normal tubes.
  • It is, however, more common after tubal surgery.
  • Ectopic pregnancy can lead to major blood loss and requires treatment which will often involve removal of the tube.
  • An ultrasound scan is advised at 6 weeks into any pregnancy to rule out an ectopic pregnancy.