The role of laparoscopy in the evaluation of candidates for sterilization reversal

Abstract

An algorithm that avoids preliminary laparoscopy for sterilization reversal (SR) candidates with previous Pomeroy, loop, Hulka clip, Irving, and single-burn cautery tubal ligation techniques was used. Anastomosis was attempted only when it could be anticipated that the final length of at least one tube would be 3 cm or more. Of 259 SR candidates evaluated according to the algorithm, 235 had SR procedures. Seven of 185 patients (3.8%) who did not undergo laparoscopy were found to have inoperable tubes at laparotomy. Four of these patients had histories of a prior unilateral salpingectomy. The authors conclude that, given their criteria for proceeding with tubal anastomosis, laparoscopy can be avoided in properly selected SR candidates. The results also indicate that patients with a history of unilateral salpingectomy should undergo preliminary laparoscopy.An algorithm intended to minimize both the preliminary screening laparoscopy and futile laparotomies was used on 259 consecutive women presenting for sterilization reversal, and the results evaluated. Records were reviewed from 1979 to 1986. First a history, preoperative exam and evaluation including semen analysis, and review of operative records were made. Women with Pomeroy, single-burn cautery, loop, clip or Irving tubal ligations were scheduled for laparotomy for microsurgical reanastomosis. Those with multiple burn tubal ligations or unknown procedures had screening laparoscopy. Of these, women with at least 1 tube 3 cm long underwent laparotomy. Results were considered in terms of successful reanastomosis procedures, since no pregnancy data were available. Of the 8 women who had futile laparotomies, 4 had unilateral salpingectomy and a contralateral Pomeroy ligation, but insufficient tube remained for reversal; 2 others had single-burn cautery, but had insufficient tube length, and the Pomeroy procedures in 2 others left insufficient distal tissue. The benefit of this algorithm was that 71.4% of patients avoided laparoscopy, but the cost was that 7 (3.8%) of these had futile laparotomy. The authors concluded that using 3 cm for the criterion of tube length was optimal, but an unnecessarily high proportion of women had futile operations because of only 1 operable tube, so they recommended that the algorithm be altered to reflect this finding. There could still be inappropriate surgeries due to inaccurate operative records or discrepancies between observations during laparoscopy and actual laparotomy.