Abstract

PIP: Over the August 1978-August 1984 period, 22 patients had a microsurgical reversal of a sterilization procedure. Each of these patients was interviewed with her spouse. Operative notes were reviewed. Ovulation was confirmed by basal body temperatures and sperm counts were evaluated. Preoperative laparoscopy was performed only when a unipolar cautery method had been the sterilization procedure as advocated by Henderson. The results of laparoscopy were discussed with the patient before microsurgery was scheduled. Chances of success were related to the amount of the tube remaining. The most important reason for reversal was the loss of a child (10/22), followed closely by a new partner (8/22). Other reasons were change of mind (3/22) and guilt (1/22). The age range at the time of the reversal was 25-40 years, with an average of 27 years. The most frequent procedure was the Pomeroy method in 15 patients, all but one performed postpartum. 2 were by Falope rings, 4 by unipolar cautery, and 1 by a double burn Waters technique. Time intervals from sterilization to microsurgical reversal range from 3 months to 12 years. The average interval was 4 years. Basic microsurgical techniques were used as described by Gomel with some variation. All procedures were done with loupes. Intrauterine pregnancy occurred in 14 of the 22 patients. 1 patient had a stillborn infant in the last trimester. There were 2 early abortions. 1 of these patients subsequently delivered a term infant. There were no ectopic pregnancies. Silber reported the importance of tubal length. This series showed no such critical relationship. Vasquez reported the longer the time interval from sterilization to reversal, the less successful the procedure. This was not supported in this series. Rock reports a high incidence of pathologic findings in the proximal segments of the tubes, most particularly, after cautery sterilization. This was supported in this series. All patients except 1 had a hysterosalpingogram at 6-8 weeks postoperatively. The patient who missed her Xray has delivered at term. 1 patient had patency unilaterally. She also has delivered at term. The reminder of the series have bilaterally patent tubes. There was no relationship to age and successful pregnancy. The older patients in this series had surprising success.