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Tubal Reversal and Scar Tissue: Should You Be Concerned?

Tubal Reversal and Scar Tissue
Will scar tissue be a problem?

Tubal reversal surgery and scar tissue: Will your reversal be successful?

tubal-reversal-and-scar-tissue-absent

Laparoscopic instrument showing normal uterus without scar tissue present.

Tubal reversal surgery can be more difficult when scar tissue is present. The most common cause of scar tissue is C-section surgery.

Most women who have C-sections will not have scar tissue; however, some women can develop significant scar tissue after c-section surgery. The more C-sections a woman has then the greater the chance of forming scar tissue.

Scar tissue caused by  C-sections can make tubal reversal surgery much more difficult.

In our experience, most women with a history of C-section are good candidates for tubal reversal surgery.

To increase the success of reversal surgery, we offer patients screening laparoscopy. A screening laparoscopy is a nice insurance policy when planning tubal reversal surgery and scar tissue is possible.

Tubal reversal and scar tissue: What is the chance of scar tissue after a C-section?

tubal-reversal-and-scar-tissue

Arrow demonstrates uterus scarred to abdominal muscles

C-sections and tubal ligations are common surgeries. Having a C-section increases your risk of having scar tissue.

Scar tissue can be external (immediately underneath the skin incision) or internal (between the uterus and the muscles).

External scar tissue is almost never a problem during tubal reversal surgery, but internal scar tissue can make reversal more difficult.

Internal scar tissue is referred to as adhesions. Internal adhesions (scar tissue) are often described as being:

  • thin and filmy (easy to remove)
  • thick and severe (harder to remove)

Thin adhesions will not increase the risk of surgery. Severe adhesions can increase the difficulty of tubal reversal surgery and may increase the chance one or both tubes cannot be repaired.

Black arrow demonstrates uterus adherent to muscles. Red arrow demonstrates intestines adherent to muscles

Black arrow demonstrates uterus adherent to muscles. Red arrow demonstrates intestinal adhesions.

Most women with C-sections will not have severe scar tissue but as the number of C-sections increases then the chance of having severe scar tissue increases.

Although it is possible to have severe scar tissue with only one C-section it usually takes multiple C-sections to increase the chance of scar tissue formation. Multiple C-sections is defined as having three (3) or more C-sections.

We estimate about 1 out of 15 women with multiple C-sections will have severe scar tissue complicating reversal surgery.

We have performed tubal reversal on women with as many as nine (9) C-sections and have not seen any scar tissue but we have seen severe scar tissue in patients who have had only one (1) C-section.

What increases the risk of scar tissue after a C-section?

The risks of developing severe scar tissue after a C-section are increased by several factors:

  • Having multiple (3 or more) C-sections
  • Classical Cesarean delivery (vertical incision on the uterus)
  • High transverse Cesarean delivery (high transverse incision on the uterus)
  • Pre-existing severe scar tissue diagnosed during Cesarean
  • Poor surgical technique
  • Internal bleeding after Cesarean
  • Infection after Cesarean
  • Maternal obesity (BMI>30)

Most women with a history of C-section will not have severe scar tissue and will be able to have a successful and safe tubal reversal and pregnancy.

Tubal reversal and scar tissue: Our recommendations in patients with a history of C-sections

We recommend patients with a history of C-section send us their C-section and tubal ligation operative report for review.

More information: Who should consider laparoscopy during tubal reversal?

scar-tissue-free-at-time-of-reversal-surgery

No scar tissue around uterus

Although we can never be certain how a patient heals after their last C-section, a patient has a greater chance of having severe scar tissue if it was present at the time of their C-section/tubal ligation.

We encourage patients with a history of C-section to have a screening laparoscopy during their tubal reversal surgery.

Laparoscopy: Nice insurance policy with tubal reversal and scar tissue

Tubal reversal and scar tissue? A screening laparoscopy is a helpful insurance policy. A screening laparoscopy allows us to examine the uterus and tubes with a small camera inserted through a small incision made inside the umbilicus (belly button).

tubal-reversal-and-scar-tissue-makes-reversal-more-difficult

Black arrow demonstrating uterus adherent to abdominal wall muscles

If the tubes are not repairable then screening laparoscopy patients are offered a refund of their tubal reversal surgical fee.

If severe scar tissue is discovered then a more appropriately placed abdominal  incision can be made to help avoid the scar tissue.

A screening laparoscopy procedure allows patients to obtain a refund if tubal reversal is not possible and can increase the chance of successful reversal if severe scar tissue is diagnosed before making and incision.

For more information on how screening laparoscopy helps increase the chance of reversal success: Tubal Reversal Insurance: Laparoscopy A Great Insurance Policy

 

 


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16 Comments

Lauren Reply

Hi,

I have also had 5 c-sections and was noted I had significant scar tissue during my last (done in 2018). If scar tissue is apparent, is it possible to remove some during a TR surgery?


    Dr. Monteith Reply

    Lauren
    We should be able to help you. You should consider our screening laparoscopy because of your history of c-sections and the possibility of scar tissue.

    We charge $6,900 for tubal reversal surgery. You should send us your records from your tubal ligation for a free review. Sometimes patients cannot get their records. Even if you cannot obtain your records we would perform tubal reversal for you because we can reverse most tubal ligations most of the time.

    Tubal reversal can be 60% to 70% effective. The other treatment to become pregnant is In-vitro Fertilization (IVF) and this treatment cost averages $14,000 and is about 40% effective for each try.

    Tubal reversal is possible when you have a history of multiple c-sections. We have many patients who have successful reversal and pregnancy with a history of c-sections. The biggest concern with multiple (3 or more) c-sections is the possibility of severe scar tissue. If severe scar tissue exists then reversal may not be possible.

    We estimate that about 1 out of 12 women with 3 or more c-sections will have severe scar tissue that can make tubal reversal more challenging and in some cases not possible. For these patients we offer a screening laparoscopy. You can consider this similar to a surgery insurance policy.

    The laparoscopy costs an additional $2,000.

    If you choose to have a screening laparoscopy we can look with a camera during the surgery and see if you have severe scar tissue. If you have severe scar tissue we can often make a different incision…so this can increase the success of your procedure. If your tubes are not repairable or the scar tissue is too severe then we would offer you a refund of your surgical fee.

    For more information: Screening laparoscopy and surgery refund

    For more information: Screening laparoscopy and scar tissue

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

    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


Lawanna C Watson Reply

Ive had 5 c sections and want one more baby


    Dr. Monteith Reply

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

    Here are the steps to scheduling tubal reversal surgery: 5 Simple Steps To Scheduling Tubal Reversal Surgery

    If you want to understand our surgery process then we encourage you to watch this video: Tubal Reversal Surgery: The Process With A Personal Choice

    The first step to see if you are a candidate is to send us your tubal ligation reports to us 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.

    This video will explain how you can determine if you are a candidate for tubal reversal surgery: Tubal Reversal: Are you a candidate?

    We charge $6,900 total plus $150 to schedule and we are located in Raleigh, North Carolina.

    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 $6,900 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.


Jordan Reply

I’m 28 I’ve had 3 c-sections my last one was 4 years ago when I got my tubes tied , I now want to have tubal reversal done by the same obgyn that delivered all my kids and tied my tubes to you think I have a good chance of getting pregnant and the tubal reversal work if I go through with this ?


    Dr. Monteith Reply

    Jordan
    Most general Ob/Gyns don’t offer tubal reversal. If they do perform the surgery they do not do very many and may not have the same success rates as an expert that does them every day. We would recommend you see a doctor who performs tubal reversal surgery daily. Visit our website https://www.tubal-reversal.net or call us at (919)977-5050 if you are interested in having reversal surgery at our office.

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