Page 305 - EJMO-9-3

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

Table 1. Patient characteristics Previous studies have shown that tubal reanastomosis
outcomes largely depend on several key factors. For
Parameters Number (n=23) example, younger women tend to have higher pregnancy
Age (years) 33.8±6.3 rates. Other favorable factors include shorter intervals
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Tubal ligation method (%) since sterilization, longer post-operative oviduct lengths
C/S (Pomeroy) 18 (78.3) (>7 cm), and the site of anastomosis, with isthmus–isthmus
L/S BTL 5 (21.7) connections proving most effective. In addition, another
Interval between sterilization and 70.43±40.01 study suggests that the type of original sterilization method
reversal (months) also plays a critical role—less invasive methods, such as clips
Successful reversal of tubes by HSG (%) or rings, are associated with higher reversal success rates
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Bilateral 11 (47.8) than electrocautery. A remaining tubal length of at least
4 cm after reversal is also associated with better pregnancy
Unilateral 7 (30.4) outcomes. Collectively, these factors are key determinants
No passing 5 (21.7) of fertility restoration success after tubal reversal.
Overall pregnancy 10 (43.5)
Tubal ligation method (%) At present, IVF is frequently selected as the initial
treatment after tubal ligation. The primary factor in deciding
C/S (Pomeroy) 7 (70) p=0.401 between tubal reanastomosis and IVF is the likelihood of
L/S BTL 3 (30) achieving pregnancy, as the ultimate aim is to conceive.
Abortion (%) 2 (8.7) Direct comparison of pregnancy outcomes is challenging
Live birth (%) 8 (34.8) because IVF pregnancy reports are either mandatory or
Notes: Data of age and interval between sterilization and reversal are standardized, unlike those for tubal reanastomosis. Thus,
represented as mean±standard deviation; data of other parameters are outcomes should be evaluated on an individual basis,
expressed as n (%). considering additional factors, such as cost-effectiveness,
Abbreviations: C/S: Cesarean section; HSG: Hysterosalpingography; ease of the procedure, potential complications, side effects,
L/S BTL: Laparoscopic bilateral tubal ligation.
personal preference, coexisting infertility factors, and the
methods. The overall pregnancy rate in the current study availability of skilled surgeons. Only two studies have
was 43.5%, which was lower than the pregnancy rate in compared the pregnancy outcomes of tubal reanastomosis
the laparotomy tubal reanastomosis group in the previous and IVF for women seeking conception after tubal ligation.
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study. In addition, laparoscopic surgery may be preferred Boeckxstaens et al. reported live birth rates per patient
due to a shorter hospitalization duration. Nonetheless, a of 59.5% for tubal reanastomosis and 52.0% for IVF, with
surgeon’s preference and experience, as well as hospital no significant difference. A meta-analysis by van Seeters
et al. found that both pregnancy and live birth rates were
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conditions, are the prominent factors in choosing tubal generally higher in the tubal reanastomosis group than in
reanastomosis methods.
the IVF group. In women over 40, one study found that
Every surgical method for tubal reanastomosis has a although tubal reanastomosis historically showed higher
generally acceptable success rate range. A 2017 systematic pregnancy rates, IVF now achieves competitive success
review of pooled data reported consistent pregnancy rates, is often more cost-effective, and carries lower
rates ranging from 42%, 68% to 65% for laparotomic procedural risks. IVF also offers the advantage of embryo
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macrosurgical, laparotomic microsurgical, laparoscopic cryopreservation for future use, despite potential increases
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microsurgical, and robotic technique, respectively. in obstetric complications and the risks associated with
Pregnancy outcomes after tubal reanastomosis, however, multiple pregnancies. The choice between IVF and tubal
are influenced by more than just surgical technique. The reanastomosis should consider the individual’s fertility
mother’s age is the primary determinant. Data from over circumstances and preferences, with IVF generally
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14,000 individuals suggest that pregnancy rates are higher recommended for its efficiency and safety in older women.
among younger women. Specifically, the pregnancy rate On the other hand, the benefits of tubal reanastomosis
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for women under 30 was 76.3% (confidence interval: include being a one-time, typically minimally invasive
53.0–99.5%), and it declined with age: 60.6% for women outpatient procedure, where patients can try to conceive
aged 30–35, 59.4% for women aged 36–39, and 52.4% for monthly without additional interventions and potentially
women aged 40 years and older. In the present study, the achieve multiple pregnancies.
mean patient age was 33.8 ± 6.3 years, and the pregnancy While tubal reanastomosis offers a viable path to
rate was 43.5%, slightly lower than previously reported. restoring natural fertility, the inherent risk of ectopic

Volume 9 Issue 3 (2025) 297 doi: 10.36922/EJMO025150111