Successful term pregnancies after tubal anastomosis utilizing contralateral tubal segments
West, S.T.; Marana, R.
International Journal of Fertility 34(1): 34-36
1989
ISSN/ISBN: 0020-725X PMID: 2565302 Document Number: 367071
Microsurgeons who perform tubal sterilization reversal occasionally encounter major anatomical defects, especially after laparoscopic unipolar cauterization. Traditional approaches in cases of severe tubal damage have included tubouterine implantation of a short tubal segment, ampullary salpingoneostomy, or a double procedure involving anastomosis and salpingoneostomy; however, all 3 approaches are associated with poor results in terms of achieving pregnancy. In 1 such case reported in the literature, in which there was no left distal fallopian tube and an unsuitable right cornual area for anastomosis, the microsurgeon anastomosed the distal segment of the right tube with the proximal segment of the left tube. The authors utilized a similar technique in a series of 10 women who presented for sterilization reversal with severe tubal defects. The 2 best contralateral tubal segments for selected and an oophorectomy was performed on the side of the nonutilized distal segment. 3 of these women achieved a term pregnancy. Another became pregnant 3 times, but spontaneously aborted in the 1st trimester, presumably due to a malformed uterus. Attachment of the newly constructed tube over the posterior wall of the uterus--a possible complication--was not observed in this series. Laparoscopy 1 year after microsurgery revealed patency of the newly constructed tube in 2 additional women. On the basis of this experience, more widespread use of contralateral tubal segments in selected cases is recommended in sterilization reversal to maximize the chances of achieving a full-term pregnancy.