Tubal Reversal Blog ‘tubotubal anastamosis’

Tubal ligation is a surgical procedure that blocks the fallopian tubes to prevent pregnancy. Many people commonly refer to tubal sterilization as having their ‘tubes tied’. The more correct medical term is tubal occlusion (occluding or closing the tube), because not every fallopian tube is ligated or tied when it is closed. There are many different ways to perform a tubal ligation, but all the procedures cause some destruction of the fallopian tubes. There are many ways to perform a tubal ligation: tying and cutting, cauterizing (burning) and clipping or banding the fallopian tubes are the most common techniques.

Tubal Ligation: A Common Surgical Procedure

Tubal ligation is a very common surgical procedure in the United States. The Center for Disease Control (CDC) and Prevention investigated surgical sterilization in 1995 and discovered 10.6 million women in the US had a tubal ligation procedure. Tubal ligation was twice as common as vasectomy. The study also found 1 out of 4 women desired a tubal ligation reversal at some point in their lives.

Tubal Ligation Reversal

A large number of women will regret their decision to have a tubal ligation and want to have another baby. According to the CDC study of 1995, more than 2.5 million women in the US will want to have their ‘tubes untied’. Many of these women are unaware that tubal ligation reversal exists, or they may be told that treatment by in vitro fertilization (IVF) is their only option. Most of these women will abandon hope of becoming pregnant again.

Untying Fallopian Tubes

Just as the expression of having the ‘fallopian tubes tied’ is commonly misused,  the description of ‘untying your fallopian tubes’ has also become a frequently used, but inaccurate description of what actually occurs during tubal surgery to repair blocked tubes. More accurate terms for this type of surgery are tubal ligation reversal or tubal reversal. There are several ways to repair fallopian tubes after a sterilization procedure. Tubotubal anastamosis is the most common technique for performing tubal ligation reversal surgery. These illustrations show the method of tubotubal anastomosis (also called tubal anastomosis or tubal reanastomosis).

Tubal ligation involves closing the fallopian tubes by destroying a portion of the fallopian tube, which causes the tube to heal closed. Tubal ligation reversal involves opening and rejoining the closed ends of the fallopian tubes. This procedure is done under magnification using microsurgical techniques and is very successful in allowing women to become pregnant. When performed by the tubal reversal doctors at Chapel Hill Tubal Reversal Center,  70% of women will become pregnant after a tubal ligation reversal.

Tubal Reversal Cost

We provide affordable tubal reversals at Chapel Hill Tubal Reversal Center. We specialize in outpatient microsurgical tubal ligation reversal. We annually perform over 800 reversal surgeries every year and patients travel from across the United States and the world to have tubal ligation reversal at our center. We have developed special techniques to allow tubal reversal surgery to be affordable, safe, and highly effective. Our tubal reversal pregnancy rates, tubal reversal pregnancy testimonials, and patient satisfaction messages are testaments to our leadership in the field of tubal ligation reversal surgery.

Tubal Reversal Experts

The tubal ligation reversal experts of Chapel Hill Tubal Reversal Center are experienced at sterilization reversal. Many women who have had their ‘tubes tied’ will come to our center to have their ‘tubes untied’. Unfortunately, a ligation reversal is not as easy as ‘untying’ the tubes- we wish the process was that simple.

We employ a microsurgical approach to repair and reattach the ends of the tubes. This process is called tubotubal anastamosis, and provides a patient with an excellent chance of becoming pregnant naturally. We specialize in ligation reversal and in reversal of difficult tubal ligation procedures.
We would like to present the story of one of our patients who had an atypical sterilization procedure.

Reversal of an Unusual Sterilization Procedure

The patient’s name is Ofralinda. She and her husband, Juan, came to us from Texas. Ofralinda is 35 and she works as an OSHA compliance officer. Her husband is in construction. Ofralinda desired a tubal ligation reversal in order to have more children. She had a rare and atypical sterilization procedure termed the Uchida procedure.

Uchida Sterilization Procedure

A Japanese physician, Dr. Uchida, first described this method of sterilization in 1961. This method involves removing a large segment of the fallopian tube and suturing (sewing) the cut end of the fallopian tube into the wall of the uterus. Dr. Uchida first published information about his method of sterilization after having performed over 50,000 procedures without any pregnancy failures. This is an effective but also  complicated method of surgical sterilization. Most modern physicians have never performed or seen a Uchida sterilization. We have seen several patients who have presented with a Uchida sterilization procedure and we have had success with reversal of this method.

Uchida Sterilization Reversal

Ofralinda had a 60-minute outpatient tubal ligation reversal. Her surgery went well. We found her tubes to be short (due to the large amount of tube removed with her initial Uchida sterilization) but otherwise healthy. We were able to successfully repair both of her fallopian tubes. She has since been discharged back to her home and we wish her well. We would like to hear a report of a successful pregnancy from her within the year.

Sterilization Reversal at Chapel Hill Tubal Reversal Center

We specialize in tubal ligation reversal. Our tubal ligation reversal specialists perform over 800 reversal procedures every year on women from across the world. We regularly have patients from as far away as Hawaii, Alaska, and the Caribbean. Occasionally, we will have patients from Australia, Asia, and Europe.

Most tubal ligation procedures are reversible. The pregnancy rates after reversal are generally higher than after in vitro fertilization (IVF) and we specialize in difficult tubal reversal procedures.

I started week number two at Chapel Hill Tubal Reversal Center with a beautiful ligation reversal.

Our patient was from North Carolina. She had a tubal ligation, which was done with bipolar cautery (burning) several years ago.

She went to her doctor to have her tubes tied, and after the surgery, her doctor told her, “The procedures I do are irreversible. You will never get pregnant again.” She told me she was fine with this at the time, but deep down she had feelings about why the doctor did such an aggressive procedure. She told me she thought to herself, what if she ever wanted to get pregnant again?

Well none of us can predict the future. As things so often go, she met a very special man who did not have any children. They married and together they desired a child. They came to us seeking to have her tubes untied.

I reviewed her operative note and things did not look good! Her operative note described cautery of the tube starting at the ampullary segment (the very end of the tube), and then cauterizing along the entire tube towards the side of the uterus. From the appearance of the operative note, it appeared most of the tube had been destroyed.

I recommended a screening laparoscopy to give us a quick evaluation before undergoing any surgical incisions. This would allow us to stop early if the tubes were not repairable. Unfortunately because of her Body Mass Index (BMI) issues, we were not able to proceed with a laparoscopy. Although we will perform tubal reversals for patients with BMIs up to 35, we do not perform laparoscopy for patients with a BMI over 30 due the possible increased risk of surgical complications.

This patient wanted a reversal and it was her personal decision to undergo a surgical incision so she could have an evaluation of her tubes.

As we started her surgery, we were uncertain if she would have repairable tubes. This was a wonderful patient who emanated a sense of enthusiasm and faith. She was someone you would characterize as having a beautiful personality. The entire surgical team was praying we would be able to help her.

As we started the incision, I was inwardly a little pessimistic that we would not be able to find any repairable tubes. I was afraid her doctor’s declaration about the nature of his tubal occlusions would be correct. I worried we would have to open her up, observe both her tubes having been obliterated and have to close her without doing her any good.

I was especially fearful of having to make the long surgeon’s walk. The long surgeon’s walk is the short, but measurable walk to the recovery/waiting room to give bad news to a patient’s family.

The worst thing for any tubal reversal surgeon is to have to tell a patient we could not repair their tubes. This is very comparable to a general surgeon having to tell a family their loved one did not make it through a risky surgery. To be honest, the two bad results are vastly different, but for a woman desiring tubal ligation reversal, it can feel very similar.

Things seem to happen for reasons. We found her to have good end segments and, as the operative note described, the tubes were cauterized to the very extreme side of the uterus. We were able to recover about 3cm of distal tube and found the remaining tubal lumens where they were hidden deep in the walls of the uterus. Isthmic-ampullary tubotubal anastamosis (tubal ligation reversal) was done on both sides and the average length of both tubes was about 3cm.

They ended up being short tubes. But short tubes are theoretically better than no tubes or closed tubes. We do have patients report pregnancies with tubal lengths much shorter than these.  We cannot create tubes. We can only work with what we find. Pregnancy for this patient is now very, very possible and prior to her reversal surgery, a natural pregnancy was impossible.

After the surgery, the entire team was thrilled. We never want to disappoint any patient, and we were able to give this woman both of her tubes back.

Dr. Berger and I were both very happy for this patient. We will be even happier when she reports a sticky bean to us (that’s a pregnancy for those who are not savvy to our Message Board lingo)!