Week number two: A beautiful ligation reversal
August 4th, 2008I 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)!
Tubouterine anastomosis is a tubal reversal procedure that is intermediate between 
Tubouterine anastomosis is performed when there is a healthy tubal segment near the ovary, but no segment remains attached to the uterus, following a tubal ligation procedure. It is also performed when a tubal segment attached to the uterus is scarred and has no open lumen.
