Putting Fallopian Tubes Back Together After a Tubal Ligation

Life throws you curve balls sometimes.  The decision you made to have your tubes tied was perfectly reasonable at the time.  You had no idea what life had in store for you, and now you find yourself wanting another child.  Well, you probably have some options.

Depending on what method was used to "tie" your tubes, there may be a way to put them back together.  If your tubal was done at the time of a c-section or a day or two after a vaginal delivery, there is a good chance that there is enough tube left to put back together.  If your tubal was done through a scope that was placed through a small incision in your bellybutton, then it may or may not be possible.  If the doctor put a clip or a ring on the tubes, this can usually be reversed.  If the doctor cauterized or "burned" your tubes, then it may not be possible.  Cautery, or burning, causes heat to travel through large sections of the tube and usually damages too much of the tube.  If this is what was done, then IVF (in vitro fertilization or the test-tube baby procedure) may be the only option left.  No matter how the tubal ligation was done, IVF is a possibility that should be considered.  Please see the previous blog on the subject for a full discussion on the subject.

Putting the tubes back together takes a skilled surgeon trained in microsurgical technique.  This usually means finding a Reproductive Endocrinologist, although there are a few Ob/Gyn's with enough training to do them.  Traditionally, the surgery is done by making an incision on the belly very much like a c-section incision.  A large microscope or special magnifying glasses called "Loupes" are then used to do the procedure.  The surgery can also be done through a scope placed through a much smaller incision in the bellybutton (laparoscopy), although this is technically more difficult.  Very recently, the DaVinci robotic system has made do the surgery with a scope much easier and it has great success!  I have started using the DaVinci system and have a patient with an ongoing pregnancy from it.  The system allows excellent magnification and lets the surgeon have greater control.  The system can scale down the surgeons movements, so that he or she does not need to try to make steady tiny little movements to sew the tubes back together.  He or she can make normal movements and the DaVinci turns them into tiny movements on the tubes.  Patients heal faster and return to their normal activities faster as well, because the incisions are much smaller than with the traditional, larger incision technique.

No matter how the procedure is done, the first thing that happens is that the two remaining parts of the fallopian tube are located.  When we say "tie your tubes", one imagines tying a knot or bow in the tube.  In reality, a piece of the middle of each tube is usually cut out, and the two ends of the remaining tube are sealed.  To put the tubes back together, the surgeon will find the sealed ends and cut away until he or she gets to the openings.  Very fine suture (thinner than a hair) on tiny little needles will be used to sew the inner canals of the tubes back together.  The outer coverings of the tubes are then sewn back together with slightly thicker suture.  Saline with blue dye is usually infused through the uterus and out the ends of the tubes to make sure that they are patent the whole way through.

The recovery time is usually about 4-6 weeks with the tradional larger incision method (laparotomy) and 4-6 days with the scope or DaVinci method.  The success rates vary depending on how much tube was left to put back together, the age of the patient, and whether there are any other underlying fertility problems.  They are in the 70-80% range for women under 35 and drop to 20-30% for women over 40.  One final thing to know about tubal reversals is that they are rarely covered by insurance.  Because you are the one that made the decision to tie your tubes, your insurance company does not usually feel the need to pay to reverse that, unfortunately.  Costs vary center to center, so speak to your physician about what the costs will be.