Tubal Reversal Blog ‘surgical’

Some women will develop problems after a tubal ligation procedure. Many will attribute these symptoms to Post Tubal Ligation Syndrome (PTLS) and will consider sterilization reversal. Some of these women will not have PTLS but, instead will have other underlying  medical conditions.

We started this series of articles for women suffering from adverse symptoms developed after a tubal ligation. We discussed the symptoms of Post Tubal Ligation Syndrome (PTLS), current medical studies about PTLS, and common medical conditions that can closely mimic PTLS. Like a long bus ride, we have expected most passengers to have exited this bus trip at each of their respective and appropriate stops after a thorough evaluation of the possible causes of their symptoms. If passengers are still riding, then the only stop left is PTLS.

In the past, the existence of PTLS has been widely debated but not agreed upon in various medical studies. The largest study to date, the CREST study, found no significant difference in the percentage of women with menstrual problems after a tubal ligation with a “control” group of women who did not have a tubal ligation. The authors of the CREST study concluded that adverse symptoms do not ocurr as a  result of tubal ligation. This study, however, was not designed to study the multitude of symptoms that women report after surgical sterilization.

The end of the journey

Our experience at Chapel Hill Tubal Reversal Center suggests PTLS does exist for a select group of women for whom no contributing medical, psychological, or other causes have been identified. Among this group of women, the vast majority have reported dramatic improvement in their symptoms after a reversal of their tubal ligation.

We will report the stories of several of our patients (both before and after tubal ligation reversal) who have had worsening physical and psychological conditions after sterilization and who have come to us seeking tubal ligation reversal. They will share with us their symptoms and how they have fared after tubal ligation reversal (had their tubes untied).

This is the sixth article in our fourteen part series on PTLS and associated medical conditions. Our next several articles will present patients who have suffered from worsening menstrual, physical, and emotional symptoms after surgical sterilization procedures (women who had their tubes tied).

Readers can also view patient submitted stories about their menstrual symptoms, reasons for reversing tubal ligation, and outcomes after reversal reversal surgery. Each patient’s story is listed below:

Meet Momzilla
Meet Andrea
Meet Rebecca
Meet Praybelieving
Meet Katherine

Visitors may join the PTLS Forum on the Tubal Reversal Message Board to share their experiences of symptoms after tubal ligation procedures and what happened to them after a tubal reversal.

History of Tubal Sterilization

The first tubal sterilization method was tubal ligation and resection, reported in 1881! Ligation and resection- or ‘tying tubes’ was the most common surgery for sterilization until the advent of laparoscopic surgery in the mid 1900’s. As laparoscopic surgery became more popular, electrocoagulation (electrical burning) of the fallopian tubes became a popular method of female sterilization.

Tubal Electrocoagulation Results in Burned Tubes

The first description of laparoscopic electrocoagulation, in 1962, used a type of electrical current termed monopolar current – hence the term monopolar tubal coagulation. This sterilization procedure uses electric current to destroy part of the fallopian tube. The burned part of the tube turns into scar tissue and the remaining tubal segments are separated and blocked. This was a very popular form of laparoscopic sterilization from 1970 until the early 1980’s.

Although monopolar electrocautery is a very effective form of tubal sterilization, studies showed that it had a higher complication rate than for electrocoagulation using bipolar current, where the damage to the fallopian tube (or other structures) is more easily restricted. Sterilization procedures done by monopolar current are gradually decreasing and being replaced with bipolar current. Monopolar cautery, however, is still used for tubal sterilization by some doctors.

Can Burned Tubes Be Repaired?

Patients often ask whether burned tubes can be repaired. In most cases, monopolar electrocoagulation sterilization procedures can be reversed. The success of reversal is dependent on the amount of fallopian tube that has been damaged by the electrocautery. This information is usually available in the tubal ligation operative report. When in doubt, a screening laparoscopy can be performed. Approximately 50% of patients at Chapel Hill Tubal Reversal Center will become pregnant after a reversal of a monopolar coagulation sterilization procedure.

Many people, including doctors, have been told that tubal sterilization is permanent and irreversible. Although monopolar tubal coagulation is intended to be permanent, this procedure is usually revesible. The best place for women to have their tubes ‘untied’ when they have been burned is Chapel Hill Tubal Reversal Center – the only medical facility that specializes in reversal of tubal ligation.

Submitted by Dr. Charles Monteith

Dr. Caryn M. Hertz – Director of Anesthesia

Caryn M. Hertz, MD is a Board Certified Anesthesiologist and has worked in the field for over 20 years. She has devoted her professional career to the subspecialty of ambulatory (outpatient) anesthesia. She has been working with Dr. Gary Berger at Chapel Hill Tubal Reversal Center since 1995.

Originally from Queens, New York, Dr. Hertz attended college at The Cooper Union for the Advancement of Science and Art, graduate school at The University of Pennsylvania, and medical school at the University of Rochester. She completed her residency in anesthesiology at Beth Israel Hospital in Boston (a Harvard affiliate) and at the University of North Carolina at Chapel Hill. After finishing her residency, she was employed at Duke University Medical Center for 5 years, specializing in preoperative assessment and ambulatory surgery. Dr Hertz has worked at Chapel Hill Surgical Center ever since.

Dr. Hertz says, “I am dedicated to making each patient’s surgery comfortable and safe. Working regularly with Dr. Berger has enabled me to truly optimize and continually improve the Tubal Ligation Reversal experience for our patients.”

Dr. Hertz and her family have lived in Chapel Hill since 1989. Having relocated from the Northeast, they very much enjoyed the mild weather, beautiful environment, and remarkable community here in Chapel Hill.

Dr. Berger’s Comment

One of the many things that makes tubal reversal surgery safe and comfortable at Chapel Hill Tubal Reversal Center is the close coordination among the professional staff who work together every day. This makes the tubal reversal procedure go smoothly and without any unnecessary waste of time for the patient who is under anesthesia. It is like a finely tuned orchestra, with each player knowing exactly what the other is doing. This coordinated team work comes only with constant repetition. The surgical and anesthesia staff at Chapel Hill Tubal Reversal Center practice together each day, and doing four procedures a day allows us to work toward the goal of perfection in patient care. It is the goal that we all strive for each day, with each patient, and each tubal ligation reversal. Other doctors and nurses who have visited our facility are amazed at how quickly patients recover from their operations.