Microsurgical tubal reanastomosis in a community hospital: Report of a 3-year study

Abstract

Microsurgery for reestablishment of tubal continuity after previous tubal ligation has been performed by gynecologists with increasing frequency and improved rates of success over the past decade. Prior to the use of visual magnification and ophthalmic-type surgical instruments and suture material the pregnancy rate was less than 20%. By using microsurgical techniques this relatively low success rate has been doubled and even quadrupled in some institutions. Most reports concerning tubal reanastomosis have come out of several of the large teaching centers and university hospitals throughout North America and Europe. The following 3-year study is from a typical community hospital gynecological service. While the success rate based on intrauterine pregnancy is less than that reported by many of the large institutions no patient was refused surgery because of a particular type of tubal ligation. The author was not selective concerning less desirable forms of tubal ligations which statistically have a poorer success rate than does a routine Pomeroy. A total of 32 patients underwent tubal reanastomosis using a microsurgical technique during this 3-year period. There have been 12 intrauterine pregnancies and 1 ectopic pregnancy to date giving a 37.5% success rate. The recommended method of initial patient evaluation and microsurgical technique is described and the current literature is reviewed. (authors)