Page 303 - EJMO-9-3

Eurasian Journal of
Medicine and Oncology Mini-laparotomy tubal reanastomosis outcomes

22%. Despite its widespread use, BTL must be presented introduced by Falcone et al. in 1998. The success rates of
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to patients as a permanent method during counseling. The these surgeries, varying by the specific surgical method
potential for reversal is limited, as success is not guaranteed employed, have been reported to range between 57%
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and depends on factors such as the original surgical and 84%. This article aims to share our experiences and
technique and the patient’s fertility status. Moreover, present the pregnancy rates of our patients who underwent
reversal procedures represent a significant financial barrier, macroscopic tubal reanastomosis with mini-laparotomy.
as they are rarely covered by health insurance. Emphasizing
these points before agreeing to this procedure is essential 2. Materials and methods
to ensure informed consent and minimize future regret. This retrospective study reviewed 23 patients admitted
Interestingly, 5–20% of women who underwent to Konya City Hospital, University of Health Sciences
sterilization later regret their choice, and only 1–2% seek between 2019 and 2022 who requested tubal reanastomosis,
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to have the procedure reversed. Regret over sterilization which was performed macroscopically through mini-
often stems from changes in marital status, the death of laparotomy. This study was conducted in compliance with
a child, or shifts in personal perspectives. Key predictors the Declaration of Helsinki. The data of the patients were
of dissatisfaction with the decision to undergo sterilization obtained from patient files and computer records. Written
include being young, having a new partner, experiencing and verbal consents are routinely obtained from all patients
the loss of a child, or the desire to have more children, with admitted to our hospital for use in scientific publications.
some individuals hoping to become pregnant again. For The inclusion criteria were women with prior
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women who have undergone tubal sterilization, there are tubal ligation, either through the Pomeroy technique
two main options for achieving pregnancy: laparoscopic during cesarean section or through laparoscopic
microsurgical reversal and in vitro fertilization (IVF) electrocoagulation, who subsequently desired fertility
therapy. An American Society for Reproductive Medicine restoration. All participants underwent comprehensive
(ASRM) report emphasizes the importance of considering fertility assessments, including day-3 hormone analysis,
factors such as a woman’s age, sperm quality, desire for baseline ultrasonography, and pelvic examination, to
children, the extent of tubal disease, and the surgeon’s exclude other infertility factors. Normal semen analysis
experience when treating tubal infertility. While there are of male partners was mandatory to rule out male factor
not enough studies comparing pregnancy rates between infertility. Surgical candidates were required to have
laparoscopic microsurgical reversal and IVF therapy, macroscopically suitable fallopian tubes with adequate
IVF offers higher per-cycle pregnancy rates. On the other length (>4 cm), minimal adhesions, and healthy fimbriae,
hand, tubal anastomosis for reversing tubal sterilization with no contraindications for mini-laparotomy, such as
provides higher cumulative pregnancy rates compared severe pelvic adhesions and significant comorbidities.
to IVF, with microsurgical anastomosis being the Patients were excluded from the study for several reasons:
recommended technique. Hence, both treatment options male factor infertility (abnormal semen parameters); other
should be evaluated based on patient preferences and infertility causes, including ovarian dysfunction (e.g.,
clinical factors. Moon et al. discussed the comparison diminished reserve or polycystic ovary syndrome); uterine
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of microsurgical tubal reanastomosis and IVF for fertility abnormalities (e.g., fibroids or adhesions); endometriosis;
restoration after BTL. They highlighted that while IVF is or pelvic inflammatory disease affecting tubal function.
commonly preferred for its higher per-cycle pregnancy In addition, women with unfavorable tubal conditions,
rates, tubal reanastomosis could provide better cumulative including hydrosalpinx and extensive adhesions
outcomes in specific cases, such as younger women or preventing safe anastomosis, as well as those with
those wanting multiple children. Despite the dominance medical contraindications to surgery (e.g., uncontrolled
of IVF, they suggested that tubal reanastomosis remains diabetes and cardiovascular disease), were not considered
a cost-effective and viable option, especially if training candidates. This study specifically focused on Pomeroy
for microsurgical techniques is enhanced. Their study and laparoscopic electrocoagulation sterilization methods,
advocated for recognizing tubal reanastomosis as a feasible excluding other techniques such as clips and rings. Live
alternative to IVF in modern fertility treatments. birth outcomes were the primary outcome, while the mean
Tubal reanastomosis surgery has seen various age of the patients, success rates of tubal reversal (patients
technological advances over the years. Initially performed with at least one open tube on hysterosalpingography
through laparotomy by Garcia in 1972, the procedure [HSG]), and time to pregnancy were secondary outcomes.
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was later adapted to laparoscopic methods by Sedbon In the Pomeroy technique, a segment of the fallopian
et al. in 1989, and subsequently, robotic techniques were tube is isolated and looped. A suture is then placed around
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Volume 9 Issue 3 (2025) 295 doi: 10.36922/EJMO025150111