We Wondered if Tubal Reversal Would be Possible
Dr. Monteith’s Diary - May 22, 2008
One of our 4 tubal reversal patients today had the following story.
She was from North Carolina and had three older children. She had her tubes tied several years ago. As time passed, she changed her mind and desired more children. She wanted a tubal ligation reversal and after searching the internet for the best tubal reversal doctor, she found out about Dr. Berger and she came to Chapel Hill Tubal Reversal Center to get her tubes untied.
Prior to her surgery, we reviewed her operative and pathology reports from her tubal ligation surgery, as we do with all patients. There was a shocking finding in her doctor’s description of her tubal ligation. Her doctor described removing 8 cm of fallopian tube on both sides! The fallopian tubes are normally about 10 cm in total length, and if 8cm of tube had been removed, there would be very little tube left to repair. Her pathology report, however, stated two separate 2 cm of tube lengths were the lengths of tubal segments sent to the pathologist for examination.
If the doctor really did remove 8cm of tube, then it might not be possible to repair her tubes successfully. If the pathology report was correct, then she should have good lengths left to reapproximate. Perhaps the pathology report was correct and the doctor did remove 2cm of fallopian tube but cauterized (burned) the rest. We were not sure. We had a dilemma.
Dr. Berger had initially recommended treatment by IVF. She did not want to do this, so the recommendation was made to start her operation with a screening laparoscopy . We were concerned if we proceeded straight to ligation reversal surgery, she may not have good fallopian tubes and she would have gone through an unnecessary operation.
The patient had a different plan. She declined both IVF and screening laparoscopy. Her desire was to have a tubal reversal no matter what. She reasoned if it was not meant to be - then it would not be. She was well informed regarding the possibility of us not being able to repair either fallopian tube. She wanted us to try to work with what she had. Her thinking was that any chance is better than no chance.
As tubal ligation reversal experts we were well aware of the possibility that this approach might lead to disappointment and unnecessary surgery and cost to the patient. We always want to maximize everyone’s chance of success. We never want a patient to undergo an unsuccessful operation. On the other hand, we recognize each patient is a unique person - a person with dreams and desires.
Our patients are well informed and understand the risks and potentially benefits of their treatment options. We do one thing very, very well at Chapel Hill Tubal Reversal Center: reversal of tubal ligation. The second thing we do well is allowing patients to make their own decisions regarding their health care. We do this by giving them the most complete and accurate information about tubal reversal surgery. We rarely say ‘No’ to patients who want to have their tubes untied.
There are some occasions where we may decline to perform surgery - if we believe that operating might be harmful or not have a possibility of being able to repair the fallopian tubes. We do realize a successful ligation reversal is important; however, equally as important, is a patient’s desire to try. For many of our patients the only thing worse than not having a successful ligaton reversal is not ever having tried.
This patient was the first patient of the day. We started the surgery with some fear that we might not see any fallopian tubes. Upon entry into the abdomen we did see good tube lengths and her repair went extremely well! She had a good surgical result and her total tubal lengths were about 4-5 cms on both sides.
We ended the surgery happy and content. As it turned out, this patient knew what she wanted and had confidence that it would work out. In the end, we were glad we did her reversal, allowing her make the decision that seemed right to her, and we were very glad that she was right!
Submitted by Dr. Charles Monteith
May 22nd, 2008 at 7:55 pm
What a wonderful story! We often come across patients that know what they want and they have the strength to go for it. Experience and dedication are two of the main reasons that patients come to Chapel Hill Tubal Reversal Center. There is not another place like it in the world.
May 23rd, 2008 at 6:37 am
Great story! Sometimes you have to follow your heart.
May 23rd, 2008 at 7:08 am
Patients frequently are told by their primary care doctors or tubal ligation surgeons that reversal is not possible. In the end, we are able to help many achieve their dreams, which is so very gratifying!
May 23rd, 2008 at 10:06 am
It is great that this patient took the leap of faith and wanted to proceed without knowing if there would be enough tubes left to repair. We are so glad she had a good outcome and will be trying to conceive again soon!
May 23rd, 2008 at 11:20 am
This is a great story and one of many that we hear about our patients. I’m glad this patient came to Chapel Hill and had her tubes repaired by the best tubal reversal doctor and I know we all wish her well!
May 23rd, 2008 at 11:58 am
How fortunate for this patient that she found Chapel Hill Tubal Reversal Center! We are very willing to try and help patients when other doctors may not give them options.
May 24th, 2008 at 1:20 pm
I always admire when patients step out on faith and share in the confidence that the surgeon has. Another happy ending at Chapel Hill Tubal Reversal Center and I wish her the best!
May 28th, 2008 at 11:58 am
Sometimes patients just seem to know what is best for them even in the face of advice from several experts. Fortunately they are able to conceive again and correct what they felt has been a mistake for them.
May 29th, 2008 at 9:17 am
What a great outcome to an uncertain situation. Occasionally there is conflicting medical data from previous surgery. Chapel Hill Surgical Center does try to inform patients of the most likely outcomes based on data available. Dr. Berger shows great respect for the patients’ informed decisions.
June 6th, 2008 at 12:45 pm
I am happy for this patient and the outcome of her tubal reversal surgery.