Tag Archives: tubal cauterization

Unexpected Finding During Tubal Ligation Reversal   July 10th, 2008

We periodically write case reports on patients who undergo tubal ligation reversal at Chapel Hill Tubal Reversal Center. The patient we will profile today had a ligation reversal procedure at our center last month.

She and her husband traveled to Chapel Hill from West Virginia. She is 34 years old and previously was an in-vitro fertilization (IVF) nurse. She is the mother of two children (ages 5 and 2). Her husband works as an engineer and is the father of both of their children. She had a tubal ligation after her second child because of two difficult, high-risk pregnancies.

Her first pregnancy was a vaginal birth complicated by heavy post-partum bleeding. Her heavy bleeding required a dilation and curettage (D and C) and emergency abdominal surgery to control the blood loss. She was diagnosed as having a placenta accreta. This is a condition where the placenta has invaded into the uterus too deeply and does not separate normally from the uterus at the time of delivery. She recovered from this surgery and eventually had a second pregnancy. This child was delivered by C-section and she had a Pomeroy tubal ligation done during the C-section. The operative report described tying and cutting the tubes as well as burning the ends. The pathology report described 1.5 cm tubal segments as being removed.

She explained to us, “My decision to have a tubal ligation was not done prayerfully but was more of a medically made decision.” She and her husband now desire more children in their life, and they traveled to Chapel Hill Tubal Reversal Center to have her tubal ligation reversed.

We were concerned that her doctor described in the operative report the tubal cauterization (burning) after tying and cutting the tubes. Since the mention of the cauterization was vague (we had no idea if a small segment was burned or the entire tube was burned) we discussed starting with a screening laparoscopy. Our patient was able to talk to her doctor who performed the tubal ligation. The doctor assured her only the ends of the tubes were burned. Since this can be a common practice and seemed minimal, the decision was made to proceed with ligation reversal without starting with a screening laparoscopy.

Microsurgical salpingostomy During her operation we found the right fallopian tube was abnormal. The right tube was long and healthy appearing, but there was no fimbriated end of the tube. This area is one of the most critical areas of the tube. The fimbriated ends act like millions of small fingers, which pick up the egg and direct the egg down the tube. The repair of this tube would require a more difficult microsurgical salpingostomy and creation of a ‘neo-fimbriated’ end of tube.

A microsurgical salpingosotomy was performed on her right tube. The left side was more normal- we had two tubal segments that we repaired with the usual anastomosis procedure. The entire operation was about one hour and fifteen minutes.

The story of this patient illustrates several important concepts:

1. She was a knowledgeable medical professional. She understood what it meant to have a tubal ligation. Many patients of all walks of life will have changes of heart as their lives change. Even medical professionals will make health care decisions for themselves, which later turn out to not be right for them. None of us can predict the future.

2. She was an IVF nurse and was aware of the pros and cons of tubal ligation reversal vs IVF. She and her husband decided ligation reversal was a more appropriate path for them.

3. Operative and pathology reports provide helpful information in planning for tubal repair, but they can sometimes be misleading.

4. The right tube was very difficult to repair. Often we will question ourselves as to whether a difficult tube should be repaired or should we just focus on the ‘better’ tube. We can never predict with 100% certain what will or will not work to help get a patient pregnant, so we like to give all patients the benefit of the doubt and try at all costs to open all the tubes we operate on.

We wish her and her husband a successful outcome of her tubal reversal operation and hope their prayerful decision will be soon rewarded.

Submitted by Dr. Charles Monteith

Tubal Reversal After Tubal Coagulation (Burned Tubes)   November 30th, 2007

Tubal Ligation by Coagulation or Cauterization

Bipolar tubal coagulation usually damages a small amount of fallopian tube and is an excellent tubal ligation method for tubal reversal.Bipolar tubal coagulation is a popular method of female sterilization in the United States. This tubal ligation method is usually performed through laparoscopy. With the bipolar (two-poles) coagulator, the fallopian tube is grasped between two poles of electrical conducting forceps and electrical current is passed through the tube between the two ends of the forceps. Damage to the tube is limited mainly to the small segment between the forceps. Burning two or three adjacent sites is common and generally results in the loss of a few centimeters of the fallopian tube. Bipolar tubal cauterization can be successfully reversed in almost all cases.

Monopolar tubal coagulation is a tubal ligation method that results in moderate pregnancy rates after tubal reversal surgery.Monopolar tubal coagulation is less common than bipolar coagulation tubal ligation. With monopolar forceps, electrical current spreads further along the length of the fallopian tube. Consequently, monopolar cautery tends to damage more of the fallopian tube than bipolar cautery. In many cases, the tube is also cut after it has been coagulated.

When monopolar coagulation is applied to a single site of the tube, tubal reversal can be performed without the need for further diagnostic tests. If multiple sites of the fallopian tube have been burned with the monopolar technique, we offer a screening diagnostic laparoscopy to evaluate the tubal lengths before proceeding to reparative surgery. The screening laparoscopy option is discussed further on our website.

Tubal Coagulation Reversal Success

Each year Chapel Hill Tubal Reversal Center publishes updated statistics about pregnancy rates and pregnancy outcomes among all of the women who have had tubal reversal procedures performed by Dr. Berger. The data for women who had tubal coagulation sterilizations, presented in the table below, are from our Tubal Reversal Pregnancy Study Report 2007.

Pregnancy Rates of Our Tubal Reversal Patients

The overall pregnancy rate after tubal reversal for women with tubal coagulation procedures is 68% for patients at Chapel Hill Tubal Reversal Center. To calculate the pregnancy rate, the number of women who have become pregnant is divided by the total number who underwent a tubal reversal procedure. The following table shows the numbers and pregnancy rates according to womens’ ages at the time of their tubal reversal surgery.

Pregnancy Rates After Tubal Coagulation Reversal


Age


All Women


Pregnant (#)


Pregnant (
%)

<30

168

142

85%

30-34

482

357

74%

35-39

408

260

64%

40+

130

46

35%

Conclusion

Tubal coagulation methods of tubal ligation can be successfully reversed in most cases. The pregnancy rate after tubal reversal varies with a woman’s age at the time she has her tubal reversal procedure. The pregnancy rate is 85% for women in their twenties, 74% for those ages 30-34, 64% for women in the 35-39 year age group, and 35% for women 40 years of age or older.