Reversal of Kroener fimbriectomy sterilization

Abstract

Sterilization by fimbriectomy has been thought to be irreversible. The present report describes the surgical approach and results in nine patients after microsurgical tubal reconstruction and indicates that repeated pregnancy is possible after fimbriectomy reversal. Preoperative radiographic studies were used to document cornual patency and to evaluate the length, width, and rugal pattern of the ampullary segment. A new ostium was created by transverse salpingostomy and a cuff-eversion technique by means of microsurgical methods. A tubal patency rate of 83% and an intrauterine pregnancy (IUP) rate of 44% was achieved. The mean interval from operation to conception was 6 months. There were no ectopic pregnancies. The ideal candidate for fimbriectomy reversal has tubal remnants 8 cm or longer, an ampullary width of 1 cm or greater, rugal patterns on x-ray film, and minimal peritubal adhesions. Successful reversal was associated with protrusions of the endosalpinx to form a neofimbria. The success of fimbriectomy sterilization probably depends more on complete ampullary occlusion than on absence of the infundibulum with fimbria. The role of the fimbria in ovum pickup is discussed. The IUP rate after microsurgical fimbriectomy reversal compares favorably with the IUP rate after macrosurgical end-to-end anastomosis and exceeds the reversibility rate of laparoscopic electrocoagulation sterilization.