How Tubal Reversal Surgery Is Done

If you are interested in getting tubal reversal surgery done, you may want to know how this operation is performed.  How your tubal reversal surgery is done depends upon the doctor and/or clinic you choose for the surgical procedure. Each doctor seems to have strong reasons for how he conducts this procedure. Below you will learn some of the basics of how it is performed by one practitioner.

Tubal Reversal Surgery Reverses What Was Done During Tubal Ligation

Essentially, during your original tubal ligation, your fallopian tubes were cut and then they are clipped, had rings added, ligated, coagulated (actually with this procedure the steps are the other way around), or otherwise made so the cut ends could not come into contact with each other.  This will prevent an egg from making the journey to the uterus and likewise, and more importantly, prevent sperm from traveling up the fallopian tubes to meet and fertilize the egg.

Step One in Tubal Reversal Surgery – Get to Know What the Lay of the Land Is

Although your surgeon may very well have an initial consultation to review your tubal ligation records, he still may not really know what he is going to find when he starts the operation. It’s astonishing how some records can be wrong or even incomplete.

This means the first step may very well be a laparoscopic view of the tubes to determine length and the overall health of all operating parts (ovary, fimbriae, uterus, etc.). This incision will most likely be made in your belly button. He will insert the laparoscope and view these organs.

Making the Incision for Your Tubal Reversal Surgery

Next will come the actual incision for the tubal anastomosis itself.  Generally this is done just above and parallel to the pubic bone below the start of the pubic hair. It will be a 3 or 4 inch incision depending upon your surgeon.

You will find, however, that some tubal reversal doctors will continue with the surgery using a laparoscope.  To learn more about laparoscopic tubal reversal, just visit the linked page.

How Your Doctor Views the Field of Surgery

The next choice made during the tubal reversal surgery will be how your doctor performs the surgery itself to remove the clips, cauterized areas, scars or whatever to have clean live tissue of the tubes to join. You will find some doctors swear by surgical microscopes and others have performed thousands of surgeries using surical loupes (magnifying lenses).

Each has his reason for what he uses. Most likely, it is a simple matter of how the surgeon was trained. You may wish to discuss this with your doctor, but perhaps looking at his success rate for patients with your given statistics (age, time since original surgery, previous births, etc.) will tell you more.

Suturing During Tubal Reversal Surgery

Regardless of how your surgeon views the operating field, he must remove the damaged and scarred tissue from your tubes and then reconnect the two pieces of each tube.  Your doctor will next use micro sutures to reattach the separated parts of the fallopian tubes.

Here again is another step wherein the surgeon’s own preferences are made as to how the suturing is done.  One surgeon I have discussed things with prefers to suture the fallopian tubes back together by layer but only the outer two layers.

Once the separated parts of the tubes are brought together, there are three layers where the micro sutures can be applied. Whether all three layers have sutures or only the outer most two (muscularis and serosa) again depends upon your surgeons preference and experience.

The inner is the thinnest and the one with the cilia that help to move the egg down the tube to the uterus.  By not suturing this layer, this surgeon feels that he minimizes scarring as the two pieces of the tubes heal together thus increases your chances for a successful pregnancy and minimizing your chances for an ectopic pregnancy.

But he does suture first the middle layer and then the outermost layer to be sure there is a strong connection between the two parts.  Furthermore, he will even suture the tube to the abdominal wall just to give it some support while healing.

The extra layer (lumens) will require more time for the surgery and you being under anesthesia which some doctors will try to avoid. The longer you are under, the more that can happen.  However, the surgeon mentioned above usually only takes an hour to do the surgery anyway and you can see the benefits to doing it his way.

Testing for a Clear Connection After the Suturing

Different doctors have different ways to test this but you will want one that does some kind of testing for a clear pathway before he begins sewing you back up.

If he is one that prefers to use a stent, this will be threaded through the fallopian tube from the uterus through the fimbriae first to be sure there is no blockage within the tubes themselves.

Some doctors do not use a stent because they believe it may cause some tissue damage itself. Those that do use it point to statistics which show a higher rate of pregnancy if one is used.

If a stent was not used, your fallopian tubes may be flushed with saline solution or a chromotubation will be performed. Essentially this is flushing the tubes with a dye to check to see if they are open.

Anesthesia During Tubal Reversal Surgery

The form of anesthesia that is used may be a general which puts you under or an epidural so only sensation in the area of the surgery is blocked. You may be able to ask your doctor for the one you prefer. This decision could also be up to the anesthesiologist.  All of this will most likely be determined by the form of surgery the surgeon conducts.

Type of Sutures Used for Tubal Reversal Surgery

Lastly, the sutures used in the tubal reversal surgery may be permanent or they may dissolve. This will vary with location and your chosen doctor’s preference based on his experience and surgical methods. This applies to the sutures on the fallopian tubes as well as the suture(s) used to close the incision.

Whether you just clip off the knot on both sides of the incision or clip on one side and pull depends upon whether dissolving sutures were used or not. Be sure to follow your doctor’s post-op care instructions to the letter.  This care can go a long way to helping your tubal reversal surgery to be successful in the end.