Tubal Ligation And Endometriosis
Review Of Medical Literature

Endometriosis in multiparous women

The incidence of endometriosis in the general population has been reported to range from 4% to 32%. A more realistic figure is probably 7.5%. An incidence of 7.4% was found in 42 of 566 multiparous women undergoing tubal sterilization at Baylor College of Medicine, Houston. Twelve of the 42 (29%) were less than five months postpartum. Hispanics had an incidence of endometriosis similar to that of whites and blacks. Indigent status had no bearing on the presence of endometriosis. A higher incidence of spontaneous abortion was found in patients with endometriosis, but the difference was not statistically significant.

Endometriosis in multiparous women. Kirshon B, Poindexter AN 3rd, Fast J., J Reprod Med. 1989 Mar;34(3):215.

Endometriosis After Tubal Ligation

Twenty-three (27.3%) of 84 patients discharged with the diagnosis of endometriosis had undergone tubal ligation 1-15 years (mean, 5) before this diagnosis was made. Twenty (87%) of the 23 underwent laparotomy because of symptoms consistent with endometriosis. Forty-four percent had stage I disease; 52%, stage II; and 4%, stage III. Endometriosis was the only pathologic finding in 19 women (82.6%). This study demonstrated that endometriosis is not a chance finding in women who have undergone tubal sterilization.

Endometriosis after tubal ligation. Fakih HN, Tamura R, Kesselman A, DeCherney AH. Reprod Med. 1985 Dec;30(12):939.

Endometriosis: Pathogenetic Implications of the Anatomic Distribution

The authors have reassessed the anatomic distribution of ectopic endometrium by the laparoscopic study of the location of implants, adhesions, and uterine position in 182 consecutive patients with infertility and endometriosis. The ovary was the most common site of implants with 54.9% having either unilateral or bilateral involvement. This was followed, in order of frequency, by the posterior broad ligament (35.2%), the anterior cul-de-sac (34.6%), the posterior cul-de-sac (34.0%), and the uterosacral ligament (28.0%). Adhesion formation followed the same anatomic distribution. No patients were noted to have endometriosis of the cervix and vagina. Endometriosis of the anterior compartment (anterior cul-de-sac, anterior broad ligament, and anterior uterine serosa) was significantly more common in patients with anterior uteri (40.7%) versus patients with posterior uteri (11.8%, P < .0005). Exclusive anterior compartment disease was found only in patients with anterior uteri, and significantly more commonly in patients with severely anteflexed uteri (P < .005). These data suggest that factors influencing implantation of retrograde menstrual debris include: the dependent pooling of peritoneal fluid as affected by uterine position; epithelial cell type at the site of implantation; unique ovarian susceptibility; route of entry; and mobility of the pelvic structures. The data support the Sampson hypothesis of retrograde menstruation as the primary model of development of endometriosis.

Endometriosis: Pathogenetic Implications of the Anatomic Distribution. Jenkins S, Olive DL, Haney AF. Obstet. & Gynecology. 1986 March; 67:335.

Endometriosis and the development of tuboperitoneal fistulas after tubal ligation

The present study details gross and histologic findings of 79 previously ligated fallopian tubes from 3 groups of patients. Of 20 oviducts removed after documented sterilization failure (group I), 6 revealed a process compatible with endometriosis. Four of nine previously ligated fallopian tubes removed at the Johns Hopkins Hospital (group II) were successfully injected with India ink. In two patients histologic examination demonstrated the India ink in epithelium-lined spaces that lay beyond the muscle of the tubal wall extending from the tubal lumen to the serosal surface. Fifty oviducts were studied in twenty-five patients requesting reversal of their sterilizations (group III). A higher percentage of fistulas was demonstrated in patients with less than 4 cm of remaining proximal tubal segment. Furthermore, most of these fistulas were demonstrated in patients for whom 3 years had elapsed since the original sterilization procedure. Patients sterilzed by laparoscopic cautery methods were observed to have a higher percentage of fistula formation and histologic documentation of endometriosis at the sterilization site as compared with patients sterilized by other methods. Our observations suggest that ligation of the oviduct within 4 cm of the uterine cornu may predispose to the development of endometriosis and subsequent fistula formation in the tip of the ligated oviduct.

Endometriosis and the development of tuboperitoneal fistulas after tubal ligation. Morrissey K, Idriss N, Nieman L, Winkel C, Stratton P. Obstet Gynecol. 2002 Nov;100(5 Pt 2):1065.