Reversal of female sterilization: Comparison of microsurgical and gross surgical techniques for tubal anastomosis

Abstract

Between 1977 and 1979, 34 consecutive, unselected patients had a reversal of tubal sterilization. The characteristics of 23 patients with more than a 6-month follow-up after end-to-end anastomosis are given, as are details of the operative procedures used. The overall intrauterine pregnancy rate was 56%, and the most reversible sterilization procedures, in terms of intrauterine pregnancies. were the Pomeroy, Uchida, and Falope ring (67%). The least reversible were unipolar tubal cautery (42%) and fimbriectomy (50%). Eleven patients had a microsurgical procedure (with the microscope) and 12 a gross surgical procedure. The use of the microscope was not associated with a significantly better pregnancy rate in cases matched for poststerilization tubal length, proximal and distal to the uterus. But insufficient numbers of tubal cautery reversals have been performed for an evaluation of the use of the microscope in this particular situation. The site of the anastomosis and the postoperative length of the tube were good predictors of intrauterine pregnancies. Five of six patients who had isthmus-isthmus anastomoses on at least one side had term vaginal deliveries. Likewise, 10 of 16 patients in whom the length of the longest tube was 6 cm or more had viable pregnancies, but only one of seven patients had a viable pregnancy with tubes of 5 cm or less.