Page 304 - EJMO-9-3

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

the base of the looped segment, and the encircled portion of Fisher’s exact test, and results were expressed as n (%).
the tube is excised. The ends of the tube are then left to heal p<0.05 was considered statistically significant.
separately, effectively preventing the passage of an oocyte
from the ovaries to the uterus, thus inhibiting fertilization 3. Results
and pregnancy. On the other hand, laparoscopic tubal The analysis of data from 23 patients revealed that the
ligation is a minimally invasive procedure that involves mean age was 33.8 ± 6.3 years. Of these patients, 18 patients
accessing the fallopian tubes through small incisions (78.3%) underwent tubal ligation through the Pomeroy
in the abdomen. During the procedure, the fallopian technique during cesarean section, while 5 patients (21.7%)
tubes are cauterized to prevent oocytes released from the had laparoscopic tubal ligation with electrocoagulation.
ovaries from reaching the uterus. This blockage effectively The mean duration between sterilization and tubal
stops sperm from meeting oocytes, thereby preventing reanastomosis was 70.43 ± 40.01 months. These patient
fertilization and subsequent pregnancy. characteristics are summarized in Table 1. Regarding
2.1. Surgical method surgical outcomes, tubal reversal was successful in
18 patients (78.3%), with 11 (47.8%) achieving bilateral
All patients were positioned in lithotomy, and the bladders reversal and 7 (30.4%) unilateral reversal. The overall
were emptied using a urinary catheter. After administering pregnancy rate post-reversal was 43.5% (10 patients),
either general or spinal anesthesia, the abdomens were with a live birth rate of 34.8% (8 patients). The average
accessed through a mini-laparotomy in accordance with time to conception after the reversal procedure was 3.73
surgical protocol. A surgical exploration of the abdomen ± 5.29 months.
was performed. Suitability of the tubes for reanastomosis,
the length of the tubes, adhesions with surrounding tissues, 4. Discussion
the condition of the fimbriae, and the relationship between In this study, where reanastomosis of the fallopian tubes
the tubes and ovaries were assessed.
was performed macroscopically through mini-laparotomy,
Initially, the opposing ends of the ligated tubes were 78.3% of patients had their bilateral or unilateral tubal
identified, and the fibrotic tissues were excised from patency, which were detectable on HSG, successfully
both ends using scissors. An 18-gauge epidural catheter opened (47.8% bilateral, 30.4% unilateral). Of the
was advanced from the fimbrial end and inserted into 23 patients, 10 (43.5%) achieved pregnancy, and 8 (34.8%)
the lumen of the opposite tube, which had been opened had live births.
with scissors, and then pushed toward the uterus. The
Tubal reanastomosis can be performed using
tubes were sutured using the single-layer, four-suture three different techniques: (i) microsurgical method,
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technique described by Berge et al., with 5-0 Prolene (ii) laparoscopic method, or (iii) robotic method. The
sutures aligning the serosal and muscular layers in a single laparoscopic method offers several benefits, including
layer. Subsequently, methylene blue dye was administered
through a vaginal Rubin cannula to check for patency reduced post-operative pain and the need for pain relief,
from the tubes into the abdominal cavity, while keeping decreased hospitalization duration, faster recovery, and
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the epidural catheter stationary. Following hemostasis, the improved cosmetic outcomes. Nevertheless, laparoscopic
abdomen was gently closed, and the ends of the epidural microsurgery requires a significant amount of time and
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catheter were secured to the skin surface. The epidural faces certain technical challenges. Similarly, robotic
catheter was completely removed after 48 h, and the surgery, while highly costly, also extends the duration of
patients were discharged 48 h later. They were recalled the operation and elevates the risk of complications during
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for an HSG test after 2 months. Patients whose at least the procedure.
one tube was found to be patent were considered part of The 2021 ASRM Committee Opinion recommended
the successful surgical group and were allowed to pursue microsurgical anastomosis as the preferred method for
spontaneous pregnancy processes. reversing tubal ligation. Mini-laparotomy appears to have
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similar pregnancy rates to laparoscopy, ranging from 54%
2.2. Statistical analysis to 88% versus 31% to 85%, respectively. A previous study
4
All data analyses in this study were performed using SPSS compared pregnancy outcomes after tubal reanastomosis
version 26 (IBM Corp., US). The data were assessed for using laparotomic, laparoscopic, or robotic methods among
normal distribution using histograms, Kolmogorov– women desiring pregnancy after tubal sterilization.
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Smirnov, and Shapiro–Wilk tests. Normally distributed Although the percentage of pregnancy was lowest in the
data were presented as mean ± standard deviation. laparotomy group with 52.6%, there were no significant
Categorical data were analyzed using the Chi-squared or differences in pregnancy rates among the three surgical

Volume 9 Issue 3 (2025) 296 doi: 10.36922/EJMO025150111