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Tubal Anastomosis Implantation

Microsurgical Tubal Anastomosis
& Tubal Implantation

How tubal reversal is 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.

Other terms used to describe this procedure are:

  • microsurgical tubal reanastomosis
  • microsurgical tubal reversal
  • microsurgical tubal repair

Microsurgical tubal anastomosis

Tubotubal_AnastomosisAfter opening the blocked ends of the remaining tubal segments, a narrow flexible stent is gently threaded through their inner cavities or lumens into the uterine cavity. This ensures that the fallopian tube is open from the uterine cavity to its fimbrial end. The newly created tubal openings are then drawn next to each other by placing a retention suture in the connective tissue that lies beneath the fallopian tubes. The retention suture avoids the likelihood of the tubal segments subsequently pulling apart.

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 The tubal stent is then gently withdrawn from the fimbrial end of the tube.


Microsurgical tubal implantation

Tubouterine_ImplantationIn some cases, a tubal ligation procedure leaves only the distal portion of the fallopian tube and no proximal tubal opening into the uterus. This may occur when monopolar tubal coagulation has been applied to the isthmic segment of the fallopian tube as it emerges from 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. Another situation where this procedure is useful is when sterilization has been performed with the Essure technique, in which case the implant is removed after the uterine incision has been made.

This microsurgical procedure is called tubal implantation, tubouterine implantation, or uterotubal implantation. Dr. Monteith performs microsurgical tubal implantation if microsurgical tubal anastomosis is not possible due to the absence of a proximal tubal segment and interstitial tubal lumen (see fallopian tube anatomy).

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Theresa Reply

Hi I am 43 and i was told that i have salpingitis isthmica nodosum will this be good for me to do

    Dr. Monteith Reply

    It is harder to become pregnant with increasing age…each year you wait you lose 12 chances and each year the chances become less. I would not wait too long if you are going to have tubal surgery or IVF.

    We can repair tubes damaged by Salpingitis Isthmica Nodosum. You would need a tubouterine implantation. This is where we remove the diseased segment and reimplant the healthy tube into the uterine wall. The chance of pregnancy is 40% and we recommend a c-section for all future pregnancy. The cost is $7,900 total.

    Look on our website and all the information regarding Essure reversal would be applicable to your condition. To reverse Essure we use the same technique as we would for your tubal repair (tubouterine implantation).

    Here is more information: Tubouterine implantation

Anonymous Reply

I have had an adiana sterilization procedure done along with an endometrial ablation. I still have a menstrual cycle every 21 days lasting 3-7 days. What is the percentage rate on success after these 2 procedures for reversal and also pregnancy?

    Dr. Monteith Reply

    In general it is recommended that you do not become pregnant after having an ablation procedure.

    Tubal reversal and pregnancy are possible if you are having regular periods of at least 3 days duration after your ablation. All pregnancies after ablation are considered high risk. Most IVF doctors will recommend using a gestational surrogate. IVF costs average $14,000 and you will have to pay the surrogate even more.

    If you are not having periods then we would not consider you a candidate for reversal. There is no medical treatment to make your periods return.

    Ablation will decrease the chance of pregnancy because it permanently damages the lining and muscle of the uterus.

    If your periods are light then you do have some functioning endometriumm but we are not always certain if it is enough to allow for pregnancy. There is no accurate way to be certain.

    We cannot provide an accurate percentage about the success of women getting pregnant after reversal with a prior ablation because there are no large scale studies looking at this. We have had women become pregnant naturally after tubal reversal with a prior ablation but don’t have a large enough group of these patients to provide meaningful statistics.

    You can see our patients who have had pregnancy success after endometrial ablation here: Ablation pregnancies

    Studies looking at women who have become pregnant after ablation show that about 50% will miscarry and about 50% will have live born babies.

    You should read these six articles I wrote about ablation, reversal, and the risks of pregnancy: Tubal Reversal and Ablation

    The ablation will decrease the chances of pregnancy but if you are having regular monthly periods of at least three days duration then pregnancy is certainly possible. If you are not having regular periods then I would advise against a reversal because pregnancy is not likely.

    In general pregnancy is not recommended after ablation because each pregnancy is at higher risk; miscarriage, growth restriction, early delivery, c-section and adherent placenta. The literature suggests pregnancies are at higher risk but many will do well.

    It is possible to become pregnant after having an endometrial ablation and then a tubal reversal and have a healthy pregnancy if you are having regular periods of at least three days duration every month. Please call us at (919) 977-5050 if you have any additional questions about tubal reversal.

    To be considered a candidate by our office you need to be having regular periods (every month) and these periods need to last for at least three days.

    All patients with ablations need a consult with me (Dr Monteith) either by phone or in person before they can schedule reversal surgery.

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