Successful term pregnancies after tubal anastomosis utilizing contralateral tubal segments

Abstract

In performing reversal of tubal sterilization, the microsurgeon sometimes has to face difficult anatomical situations due to extensive tubal damage, particularly after laparoscopic unipolar cauterization. In a recent case report, a technique of utilization of contralateral fallopian tube segments in tubal reanastomosis has been described. An intrauterine pregnancy followed, which resulted in a spontaneous abortion at 8 weeks' gestation. We report here our experience in ten cases utilizing a similar technique. Three patients achieved a term pregnancy. One patient achieved three intrauterine pregnancies that ended in first-trimester abortions. It is felt by the authors that this technique should be kept in mind by the practicing microsurgeon for selected cases.

PIP: Microsurgeons who perform tubal sterilization reversal occasionally encounter major anatomical defects, especially after laparoscopic unipolar cauterization. Traditional approaches in cases of severe tubal damage have included tubouterine implantation of a short tubal segment, ampullary salpingoneostomy, or a double procedure involving anastomosis and salpingoneostomy; however, all 3 approaches are associated with poor results in terms of achieving pregnancy. In 1 such case reported in the literature, in which there was no left distal fallopian tube and an unsuitable right cornual area for anastomosis, the microsurgeon anastomosed the distal segment of the right tube with the proximal segment of the left tube. The authors utilized a similar technique in a series of 10 women who presented for sterilization reversal with severe tubal defects. The 2 best contralateral tubal segments for selected and an oophorectomy was performed on the side of the nonutilized distal segment. 3 of these women achieved a term pregnancy. Another became pregnant 3 times, but spontaneously aborted in the 1st trimester, presumably due to a malformed uterus. Attachment of the newly constructed tube over the posterior wall of the uterus--a possible complication--was not observed in this series. Laparoscopy 1 year after microsurgery revealed patency of the newly constructed tube in 2 additional women. On the basis of this experience, more widespread use of contralateral tubal segments in selected cases is recommended in sterilization reversal to maximize the chances of achieving a full-term pregnancy.