Tubal ligation reversal

Tubal ligation reversal is a surgery done to reopen the fallopian tubes in women. Tubal ligation cuts and ties the fallopian tubes to prevent fertilization and pregnancy. However, tubal ligation reversal helps an individual get pregnant by restoring fertility. It is also called tubal reversal or tubal sterilization reversal. The previous tubal ligation is undone by this method. This helps the egg reach the sperm for fertilization.

Anatomy:

The female reproductive system consists of the following:

ovaries that produce eggs that combine with sperm to make a baby
Fallopian tubes that collect eggs from the ovary
Uterus – sac where a baby grows
Cervix – that opens the uterus to the vagina
Vagina – a part that opens outside

Principle:

Tubal ligation depends on the principle that when the fallopian tubes are cut and stitched, they do not collect eggs produced by the ovary. As there are no eggs, the sperm cannot fertilize them. As there is no fertilization, pregnancy does not occur. This leads to birth control. Whereas in tubal sterilization reversal, the tubes are reconnected so that the egg produced from the ovaries can reach the sperm for fertilization.

Indications:

Not all candidates are indicated for reversal of tubal ligation. Many factors should be considered for tubal ligation reversal. They are:

Young age women have better chances of getting pregnant than old age. Old age also increases the chances of giving birth to babies with birth defects.
Women with regular menstrual cycles and no fibroids or endometriosis (uterine conditions) can have tubal ligation reversal.
Tubal ligation methods where the fallopian tubes are clipped or ringed have better success rates of reversal.
Having adequate length of the fallopian tubes also helps in the success of the tubal ligation reversal
Having the same diameter of the tubes on both sides and at least 3-4 inches after the initial ligation increases the success of the procedure.

Contraindications:

Women with uterine fibroids
High body mass index
Life-threatening conditions or any diseases that affect the pregnancy
Pelvis scars
Uterine condition of endometriosis
Improper sperm health of the partner
Procedure of ligation where the fallopian tubes were burnt
Improper sizes of the fallopian tubes like one closed end bigger than the other
Ligation process where most of the fallopian tubes are removed

Advantages:

An individual can get pregnant if the reversal is successful

Before the procedure:

Before undergoing the procedure, one should discuss the necessity and type of the ligation reversal procedure by discussing it with the healthcare provider (HCP). One should opt for this procedure if they want to have a pregnancy. Partners or couples can also opt for other birthing methods like invitro fertilization if they want a baby.

The HCP collects information regarding previous pelvic surgeries, medications, allergies, and medical history. Necessary tests like blood tests are done to understand the physical fitness for surgery. A pregnancy test is conducted to check if an individual is pregnant.

Details regarding the previous ligation methods are also collected to check if the candidate is fit for the reversal procedure. It is advisable to have the previous ligation reports. Smoking, alcohol, and caffeine can hinder the healing process. Hence, it is advisable to refrain for a few days.

During the procedure:

Tubal ligation reversal is done under general anesthesia. A tube known as the catheter is put in the bladder to collect the pee. Access to the fallopian tubes is obtained by a single cut or many small cuts. The type of cuts depends on the type of procedure done for tubal ligation reversal.

If a mini-laparotomy is performed, single 2-inch side-to-side cuts are made below the bikini line. Using an operating microscope the fallopian tubes are accessed. An assessment is done to check if they can be reconnected. If there is an option of tubal reversal, the tubes are reconnected.

If robotic-associated laparoscopy is performed, several small cuts are made in the abdomen. The robotic arms of the laparoscope are controlled through a console. Based on the assessment, ligation reversal is done by connecting the blocked ends of the tubes.

Dyes are injected through the uterus to check the opening of the fallopian tubes. If the dyes flow freely it indicates proper connection of the fallopian tubes. Later the incisions are closed with dissolvable sutures and the surgical site is bandaged.

After the procedure:

The tubal ligation reversal takes about 2-3 hours. An individual is monitored till the vitals are stabilized and they are discharged once stable. Medications are given for pain, to prevent infections, and to avoid vomiting. It takes about 1-2 weeks for recovery and to resume normal activities.

Effectiveness:

Tubal ligation reversal is considered successful if the individual gets pregnant. One has to wait for 2 cycles of periods at least before planning pregnancy. One can get pregnant within a year or two after the tubal ligation reversal. An X-ray dye test can be done a few days after surgery to confirm the opening of the fallopian tubes.

Instructions:

Avoid lifting heavy weights
Avoid swimming in pools, sauna baths, and hot showers for at least two weeks after the surgery
Avoid sex immediately

Risks and complications:

Pain, infections, bleeding at the surgical site, formation of blood clots, anesthesia allergy, and organ damage during surgery are some of the potential risks and complications. A medical emergency called ectopic pregnancy is a condition where pregnancy occurs outside the uterus.

Conclusion:

Tubal ligation reversal is a type of surgery to open the tubal ligation. It is done in women who want to get pregnant naturally. Considering many factors one can opt for this procedure after discussing it with their healthcare professional.

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