Tubal Ligation Reversal
With over 2000 tubal ligation reversal operations undertaken in more than 25 years I have performed more tubal reversals than any other reproductive microsurgeon currently practising in Australia. This vast experience makes it possible to obtain consistently high success rates, reassuring you of being the wisest choice of microsurgeon to undertake your tubal reversal.
Microsurgical tubal ligation reversal using a state of the art, high-powered surgical microscope and the highest quality microsurgical instruments is scientifically proven to be superior than any other method. Microsurgical techniques enable optimal visualization of the fallopian tube allowing accurate and precise placement of each suture. Using a multi-layered technique of extremely fine sutures provides far better results than other less precise methods and also allows an uneventful recovery.
Laparoscopically assisted microsurgical technique
Using my extensive experience I have developed a highly advanced laparoscopically assisted method of microsurgery, which has all the accuracy of microsurgery and the benefits of small incisions from laparoscopic methods. Using his method a laparoscopy is usually performed immediately prior to tubal reversal to ensure that there is not irreparable damage to your Fallopian Tubes. This involves a thin telescopic instrument (5mm diameter) being inserted through a 1cm incision in the umbilicus (navel) to examine the internal organs of the pelvis. The organs are separated by introducing gas (carbon dioxide) via the laparoscope. The uterus and fallopian tubes to be moved into position immediately beneath a second incision of 3cm to 4cm in the pubic hair line through which the microsurgical reanastomosis is performed. A supporting stitch is then placed through the ligaments if the ovary to keep the Fallopian Tube (to which it is attached) in position. If necessary the tube (on each side) is then dissected free of the surrounding tissue. The area of the prior tubal ligation it is then cut on either side so that a normal open tube is available for reanastomosis of each end.
Once the cut ends of the Fallopian Tube are in close proximity with each other and stabilized in position an operating microscope is then used to magnify the site of the microsurgery approximately 40 times. A series of very fine microscopic sutures (less than the diameter of a human hair) are then placed around the circumference of the lumen of the Fallopian (which is less in diameter of a pin) to bring the ends together and establish patency. A second layer of sutures is then added to provide support and stability to the site of the anastomosis Upon completion of the microsurgery the two small skin incisions are closed with very fine invisible stitches beneath the skin. Rarely, a subcutaneous drain or an indwelling urinary catheter are left in place for a short time after the operation.
Results and success rates
The success rates from tubal reversal are exceptional is excellent with over 98% of women who undergo the operation achieving open Fallopian Tubes. For the average woman undergoing tubal reversal over 80%-85% achieve pregnancy. The most important factor influencing the pregnancy related success rate is your age. The older you are, the lower the chance of a successful pregnancy. This is due the declining number of normal eggs within your ovaries as you get older. In addition, increasing age also increases the chance of miscarriage and the possibility of having a baby with a genetic problem such as Down syndrome.
The pregnancy rate also depends on the type of previous sterilisation procedure and the remaining length of fallopian tube and age. Tubal clips have the highest reversibility and diathermy the lowest. The pregnancy rates decrease with increasing age and also when a greater amount of fallopian tube has been damaged by the method of tubal occlusion. Following tubal reversal the chance of a pregnancy in the fallopian tube (ectopic pregnancy) increases from 0.3% to 1%. While uncommon, my advice is that an early pregnancy ultrasound is essential with the aim of excluding this condition. Should pregnancy not occur by 12 months following the operation the chance of subsequent pregnancy starts to fall considerably.
An important consideration is the skill and experience of the surgeon who performs your tubal ligation reversal. I am a full-time fertility specialist who concentrates on reproductive microsurgery and as such I am continually performing tubal ligation reversal procedures. In addition, I have a dedicated surgical team who exclusively assist me in performing tubal reversals. The same staff doing the same procedures, all of the time, means maximum expertise and experience available to you.
A new relationship is by far the most common reason for wishing to have a tubal reversal - but it is not the only one. A simple change of heart or family tragedies while uncommon do occur. Tubal reversal is even more successful when performed on couples in the same relationship with prior children. Occasionally tubal reversal is performed for religious belief or change in menstrual pattern.
The single most important factor influencing the prospect of successful pregnancy following tubal reversal has nothing to do with the surgery itself. It is the your age. The prospect of successful pregnancy dramatically declines with female age. For healthy previously fertile women over the age of 40 years the total probability of successful pregnancy is not greater than 40%. Indeed miscarriage rates at age 40 are 40% per pregnancy. Obviously the older you are the more likelihood that you may have some additional medical problem, which may influence that safety of surgery or the chance of complications. In addition many people will think about the difference in age between parent and child as you get older.
A range of common gynaecological problems such as fibroids, endometriosis, pelvic adhesions and ovarian cysts can all interfere with both the performance of tubal reversal and the results from the procedure.
It is important to be aware of your general state of health prior to any surgical procedure. There are a variety of conditions that may effect the outcome of your operation. In particular obesity, cardiovascular, respiratory and neurological disease may also be of major significance for your anaesthetic. Smoking has been shown to reduce fertility by affecting egg function as a result of toxins.
A normal sperm count is of considerable importance in achieving pregnancy. It is therefore wise to have your partner checked prior to your tubal reversal. General medical conditions, which affect his health, are of importance. Some medications that men take may interfere with sperm production. Smoking and heavy alcohol consumption definitely reduce male fertility.
Recovery after tubal reversal
Recovery is generally rapid with most patients leaving hospital within a day or two of tubal ligation reversal. There will be some discomfort from the operation site. As the stitches used to close the skin are both very delicate and placed just underneath the skin, it is uncommon for them to cause any problems. Gentle washing the area of the operation is permitted the day after surgery. A graduated increase in normal activity is wise.
Once you go home from hospital after your tubal ligation reversal you should be prepared to rest. Having someone to assist you for the first week would be wise particularly if your home has a staircase or is situated on an incline. In the second week post operation light physical activity is reasonable. You can aim to return to normal physical activities within about 2 to 4 weeks. Take care with physical activity during this time as excessive movement of the site of your surgery may placed tension on the wound and cause pain. From the perspective of healing the site anastomosis of the Fallopian Tube is protected within the abdomen. Common sense is important - you should only undertake light physical activity during this early recovery phase. The essential rule is: "If it hurts - do not do it."
Sex should be avoided for the first week or two after your tubal reversal, thereafter common sense should prevail. In general it is reasonable to engage in sexual activity if it is comfortable and enjoyable.
Most can return to work within 2 weeks of tubal reversal. Some people who work in sedentary occupations could do so earlier.
Possible side effects and complications
While side effects and complications are uncommon, they do occasionally occur.
Swelling is present along the wound after the operation due to tissue fluid engorging the area. This generally rapidly subsides without great difficulty. Occasionally walking is a problem until it has subsided.
Infection is rare, but should there be any dramatic increase in swelling or pain after the operation, you should contact this surgery and antibiotics will most likely be prescribed. Unfortunately any operation that opens the body to the atmosphere can have bacteria contaminate it and lead to infection.
Haematoma is a collection of blood in the wound around the site of the operation due to the leaking post-operatively of the microscopic blood vessels, which can be damaged at the time of the surgery. Blood vessels often go into spasm during surgery however bleeding can restart some time after the operation is completed and cause a haematoma.
Clots in the legs (deep venous thrombosis), which can on rare occasions, travel to the lungs (pulmonary embolus) can occur during and after any surgery. Preventative measures are always taken however such complications remain possible.
The results from tubal reversal operations are impressive. For the average woman undergoing microsurgical tubal reversal in my care, surgery is successful in leading to open fallopian tubes in more than 98% of cases.
EXPERIENCE AND EXPERTISE MATTER