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Microsurgical Tubal Reversal: How Is Tubal Reversal Performed?

Tubal ligation reversal involves microsurgical techniques to open and reconnect the fallopian tube segments that remain after a tubal ligation procedure. Usually there are two remaining fallopian tube segments – the proximal tubal segment that emerges from the uterus and the distal tubal segment that ends with the fimbria next to the ovary.

The procedure that connects these separated parts of the fallopian tube is called microsurgical tubotubal anastomosis, or tubal anastomosis for short. Often many refer to the tubal anastomosis procedure as “tubal reversal”.

We specialize in all of these procedures. We perform these procedures as outpatient surgery, at an affordable price, and provide our patients with the ability to become pregnant naturally and more than once. All of these procedures can provide an alternative to in-vitro fertilization.

Tubal ligation reversal: Microsurgical tubal anastomosis

Microsurgical tubal anastomosis reattaches the tubal segments.Fallopian tube after microsurgical tubal anastomosis.

After opening the blocked ends of the tubal segments, a narrow flexible stent is gently threaded through the fallopian tube segments and into the uterine cavity. This ensures the fallopian tube is open from the uterine cavity to the fimbrial end. The newly created tubal openings are then drawn next to each other by placing a suture underneath the fallopian tube segments. The retention suture keeps the tubal edges together, decreases tension, and avoids the likelihood of the tubal segments subsequently pulling apart.

Very fine, permanent microsurgical sutures are used to precisely align the muscular portion (muscularis) and outer layer (serosa), while avoiding the inner layer (mucosa), of the fallopian tube. The tubal stent is then gently withdrawn from the fimbrial end of the tube.

The use of permanent non-absorbable sutures is very important because it allows the tubal edges to heal together and avoids tubal scarring which may occurr when temporary no-absorbable sutures are used.

The chance of pregnancy after tubal reversal can be as high as 80%.

Microsurgical salpingostomy for fimbriectomy reversal

Microsurgical salpingostomy
The newly created opening is then enlarged and gently folded back.

Fimbriectomy is an rare type of tubal ligation and differs from other methods of tubal ligation.

Fimbriectomy tubal ligation is performed by removing the very end of the tube (the fimbrial end next to the ovary) leaving behind one tubal segment attached to the uterus. After fimbriectomy, the remaining tubal segment can be opened by the technique of microsurgical salpingostomy.

Microsurgical salpingostomy is performed by creating a small opening in the remaining end of the fallopian tube with a microsurgical needle electrode. The newly created opening is then enlarged and gently folded back like the petals of a flower to allow the internal endothelial lining to emerge and extend over the opened tubal end.

Since healthy tubal endothelium is covered with cilia – the hairline projections that beat in coordinated waves – the new tubal opening or ostium can capture an egg as it is released from the ovary and propel it into the tube just as the fimbrial end of the tube does normally. Fine sutures are carefully placed around the circumference of the folded back end of the fallopian tube to prevent scar formation and closure.

The chance of pregnancy after fimbriectomy reversal range from 15% to 40% and depends on the health and length of the remaining fallopian tube.

Microsurgical tubal implantation

Tubouterine implantation inserts the separated fallopian tube into the uterus.

In some cases, a tubal ligation procedure leaves only the distal portion of the fallopian tube and no proximal tubal opening into the uterus.

In this situation, a new opening can be created through the uterine muscle and the remaining tubal segment inserted into the uterine cavity.

This microsurgical procedure is called tubal implantation, tubouterine implantation, or uterotubal implantation.

The chance of pregnancy after tubal implantation at our center ranges from 30% to 50%.

225 thoughts on “Microsurgical Tubal Reversal: How Is Tubal Reversal Performed?”

  1. Tiffany says:

    Hello My name is Tiffany Cooper I had a ectopic pregnancy in both my tubes and they both erupted however I still have my tubes and ovaries the Dr stated that it was a small opening in both tubes, what I wanted to know was could this issue be fixed I’m married and have 3 teenage boys but my husband don’t have any that’s biologically his and I would love to give him 1 can you please let me know what my options are ,Thank you Tiffany Cooper

    1. Dr. Monteith says:

      Tiffany
      You would need to send us a copy of your HSG report and any operative reports from your tubal evaluations and we can let you know if you are a candidate for tubal repair.

  2. Kara says:

    If one of my tubes was cut more then the other one can both be mended back so I could get pregnant and how much do you charge

    1. Dr. Monteith says:

      Kara
      We should be able to help you. We can reverse most tubal ligation procedures.

      You should send us your tubal ligation reports for a free review and we can let you know if you are a candidate for reversal surgery. Your reports can be obtained from the medical records department where your tubal ligation surgery was performed.

      We charge $6400 total plus $125 to schedule and we are located in Raleigh, North Carolina.

      Please be aware that starting April 1st 2019 the fee for reversal surgery will increase to $6,900 and the scheduling fee will increase to $150. If you want to avoid the higher fees then you should schedule your surgery before April 1st or start a Reversal Prepayment Account.

      Patients pay in full and out-of-pocket at the time of scheduling. All you have to pay for in addition to the surgical fee is the cost of travel, hotel, and food.

      On average the chance of pregnancy after tubal ligation reversal is about 60% if you are under age 42.

      We do have a prepayment tubal reversal plan that allows you to save towards your reversal over a 3 year period.

      Although $6,400 seems expensive…the alternative treatment in-vitro fertilization (IVF) average $12,000 to $14,000 and is about 40% successful!

      The main advantage to tubal reversal is that every month you have a chance and you can become pregnant more than once.

      The following link will answer most of your questions about reversal. This is the MOST HELPFUL INFORMATION to read when considering reversal at our office. Each question has a link to more information about the question:

      Frequently asked questions about tubal reversal

      Call us at (919) 977-5050 8am to 5pm eastern standard time and we would be happy to speak with you about tubal reversal at our facility.

  3. Anonymous says:

    With the tube reversal i read that it takes 60 minutes to do so in some cases, correct me if im wrong, in that case is the anesthesia is local?

    1. Dr. Monteith says:

      We perform the surgery under general anesthesia. Here is more information: Best anesthesia for tubal reversals surgery

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