Tubal reversal

Tubal reversal
Intervention
ICD-9-CM	66.7
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"Tubal Reversal," also called "Tubal Sterilization Reversal," or "Tubal Ligation Reversal," or "Microsurgical Tubal Reanastomosis," is a surgical procedure that can restore fertility to women after a tubal ligation. By rejoining the separated segments of the fallopian tube, tubal reversal can give women the chance to become pregnant again. In some cases, however, the separated segments cannot actually be reattached to each other. In some cases the remaining segment of tube needs to be reimplanted into the uterus (a 'tubal reimplantation'). In other cases, when the end of the tube (the 'fimbria') has been removed, a procedure called a neofimbrioplasty must be performed to recreate a functional end of the tube which can then act like the missing fimbria and retrieve the egg that has been released during ovulation.

The fallopian tube is a muscular tube extending from the uterus and ending with attached fimbria next to the ovary. The tube is attached to the ovary by a thin tissue called the mesosalpinx. The inner tubal lining is lined with cilia. These are microscopic hair-like projections that beat in waves that push fluid down the tube towards the uterus thereby helping move the egg or ovum to the uterus in conjunction with muscular contractions of the tube.The fallopian tube is normally about 10 cm (4 inches) long and consists of several regions that become wider as the tube gets farther away from the uterus. Starting from the uterus and proceeding outward, these are the:

Tubal reversal surgeries require the techniques of microsurgery to open and reconnect the fallopian tube segments that remain after a tubal sterilization, reimplant remaining segments, or create new fimbria.

Following a tubal ligation, there are usually two remaining fallopian tube segments - the proximal (close) tubal segment that emerges from the uterus and the distal (far) tubal segment that ends with the fimbria next to the ovary. After opening the blocked ends of the remaining tubal segments, a variety of microsurgical techniques are utilized to recreate a functional tube. The newly created tubal openings are drawn next to each other by placing sutures in the connective tissue that lies beneath the fallopian tubes (mesosalpinx). The retention suture prevents the tubal segments from pulling apart while the tube heals. Microsurgical sutures are used to precisely align the tubal lumens (inside canal of tube), the muscular portion (muscularis externa), and the outer layer (serosa) of the tube. Most surgeons try to avoid the use of stents which can damage the delicate cilia that line the tube and create the flow of fluid that is needed to push the egg and embryo into the uterus. Other surgeons use a narrow flexible stent to gently thread through the tubal segments or into the uterine cavity in order to line up the tubes in order to reconnect them. In either case, once the microsurgical repair is completed dye is injected through the cervix into the uterus and out through the tubes to ensure that the fallopian tube is open from the uterine cavity to its fimbrial end. The surgeons who use stents then gently withdraw them from the fimbrial end of the tube after the repair is completed.

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Wikipedia