One of the determinants of tubal reversal surgery success is the method that was used to tie the tubes and the amount of undamaged tube remaining. There are many different tubal ligation methods. It is very important to obtain your operative report from the surgeon who performed the tubal ligation to determine the method used.
Electorcautery is used to “burn” the tubes and is one the most damaging forms of tubal ligation. Electrocautery can damage large portions of the tube and results in scarring. While tubal reversal surgery is sometimes successful it depends upon the length of healthy tube remaining.
A salpingectomy is complete removal of the fallopian tube and tubal reversal surgery is not possible. A partial salpingectomy is removal of a part of the tube and can often be reversed depending upon the quantity and quality of the remaining tubes.
The Adiana Method is employed using the hysteroscope; meaning surgery is not necessary. The hysteroscope is used to pass a catheter through the vagina, into the uterus, to the point where the tubes attach. Heat is applied to create minor damage to the tube which will stimulate new tissue to grow.
The Adiana inserts are placed at the location of the lesions and the new tissue will grow surrounding the inserts thus creating blockage. The blockage can require several months to form and alternate birth control is recommended during this period. The Adiana Method can be more difficult to reverse depending upon the damage to the tube where it enters the uterus.
The Hulka clip is made from a soft pliable plastic. In general, the Hulka clip causes the least damage to the fallopian tubes and can be reversed more easily. The clip has a spring which clamps it to the fallopian tube thus blocking egg transport. Even though the clip can be removed, tubal reversal surgery is still necessary because tissue is often damaged, which can result in scarring.
The essure device is a coil which is placed into the fallopian tube where is meets the uterus. The device causes scar tissue to form around the coils preventing pregnancy by leading to tubal blockage. Essure tubal ligation can be reversed by removing the coils as well as any scar tissue present within the tube and then reattaching the tube to the uterus.
The Filshie clip works on the same principal as the Hulka Clip but is shaped differently and is made out of titanium. It clips directly on the fallopian tube creating blockage. One or more clips may be used on each tube. Typically, tissue around the clip “dies” due to lack of blood flow. Tubal reversal surgery is usually an option in these cases.
Many different tubal ligation bands are available. The tube is shaped into a loop and the silicon band is placed at the bottom of the loop. A small amount of tissue around the band is destroyed leading to tubal blockage. Tubal reversal surgery is usually feasible.
The Pomeroy method is taught to most OB/GYN residents and is commonly used. The tube is formed into a loop and tied at the bottom. The top of the loop is cut leaving the two ends of the tube disconnected and open. Tissue grows over the openings thus blocking the tubes. The tubes remain healthy after this procedure and can usually be reconnected. Tubal reversal is more technically challenging when the diameters of the remaining tube “pieces” are significantly different. Dr. Shaykh has conducted many successful tubal reversal surgeries where the Pomeroy method was used.
The tube is cut in two places; near the ovary and the uterus, thus removing a portion of the tube and both ends are tied. Removing a portion insures that egg transport cannot occur. The procedure is often reversible depending upon how much of the tube was removed.
This procedure removes the fimbria which are fingerlike projections of the tubes where they meet the ovaries. The fimbria function to “collect” the eggs and “funnel” them into the fallopian tubes. Tubal reversal surgery is not possible in these cases.
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