Tubal ligation reversal

Tubal ligation is a female sterilisation procedure to prevent pregnancy. In this surgery, the fallopian tubes that carry eggs from the ovary to the uterus are either surgically tied or burnt. 

Tubal ligation reversal allows women who have previously undergone tubal ligation surgery, to become pregnant. In this surgery, the cut ends of the fallopian tube are rejoined to allow fertilisation. 

Since tubal ligation is a permanent sterilisation technique, reversal of this procedure is considered to be a major surgery.

Tuboplasty or tubal re-anastomosis surgery are some other names for tubal ligation reversal.

The success of a tubal ligation reversal depends on your age, the type of tubal ligation undergone (whether the tubes were cut and blocked using clips, rings, or electrocautery [a surgical procedure wherein electricity is used to heat the body tissue]), time elapsed since the sterilisation surgery, and the current health of the remaining fallopian tubes.

On average, the pregnancy rate after tubal ligation reversal surgery is about 70% to 80%. However, this surgery is rarely performed because of a higher success rate with the in vitro fertilisation (IVF) technique. Moreover, this operation is associated with a high risk of a life-threatening condition called ectopic pregnancy wherein the fertilised egg may grow in the fallopian tube instead of the uterus.

A surgeon may recommend this procedure in women who wish to have another child after undergoing tubal ligation in the past. Women usually opt for tubal ligation reversal due to changes in circumstances such as the death of a child or remarriage. However, surgeons typically recommend IVF before tubal ligation reversal.

Surgeons do not recommend tubal ligation reversal in any of the following circumstances:

• You are more than 44 years old.
• Your partner’s sperm analysis is abnormal Read more: Semen analysis test.
• You have absolute contraindications to pregnancy such as sexually transmitted diseases like HIV or diabetes.

Prior to the surgery, a preoperative assessment will be done wherein the surgeon will conduct a physical examination along with a few additional tests, namely, fertility tests, blood tests, and X-rays.

Read more: Female fertility panel

The medical team will ask your partner to get a sperm analysis test done. All of this will help decide if you are fit enough for the procedure or if you will benefit from it. The surgeon will also give you the following instructions to prepare for the surgery:

• Share your medical history.
• Share all the operative reports related to your previously performed tubal ligation surgery.
• Inform them if you consume any medicines including herbs, supplements, and over-the-counter medications.
• Stop taking medicines that affect the ability of your blood to clot. Such medications include ibuprofen, aspirin, and warfarin.
• Stop smoking. Read more: How to quit smoking 
• Avoid drinking or eating anything after midnight of the scheduled day of the surgery. This is recommended to prevent vomiting while you are under the effect of anaesthesia.
• Take a shower and remove all your body piercings, nail polish, and make-up before arriving at the hospital for the surgery.
• Make arrangements for a friend, family member, or responsible adult to drive you home after the surgery.

The surgeon will share the details of the surgery with you. If you agree to the procedure, you will be asked to sign a consent form.

Once you reach the hospital, the medical staff will ask you to wear a hospital gown. Before the operation, take your medicines with a minimum quantity of water. A needle will be inserted in a vein in your arm to provide essential fluids and medications during the surgery. The surgery usually involves the following steps:

• The surgeon will first administer general anaesthesia to put you into a deep sleep during the operation.
• He/she will introduce a laparoscope into your abdomen through your navel to check whether your fallopian tubes can be reattached. A laparoscope is a flexible, thin tube with a light source and camera at the tip.
• If the conditions are favourable, the surgeon will remove the laparoscope and make a small horizontal incision (cut) just above your pubic hairline.
• He/she will then reach for your fallopian tubes and remove any damaged portion along with any instruments that were used to close the tubes such as clips and rings.
• Thereafter, the surgeon will reconnect your severed fallopian tubes by looking through a microscope and using special instruments. This will help minimise damage to the tubes or nearby tissues.
• The surgeon will reattach the tubes with two layers of special stitches that have a diameter less than that of a human hair.
• Then, he/she will inject a coloured dye (usually blue) into your fallopian tube to check for any leakages. This will help to ensure that your tubes have been successfully reattached.
• Finally, the surgeon will close the cut using self-dissolving stitches.

The procedure requires around two to three hours. During the surgery, the surgeon will inject gas into your abdomen to expand your stomach and get a better working space. You will be discharged three to four hours following the surgery.

Tubal ligation reversal can also be done as an open surgery where a cut is placed on the abdomen, through which the severed fallopian tubes are directly visualised and reconnected.

You will recover in a week following the procedure. The surgeon will give you specific instructions to take care of yourself after the surgery. These include:

• You may experience tenderness and pain on the operated site for a few days following the surgery. The surgeon will prescribe medicines for the same. Take them as directed.
• You may also experience shoulder pain for a while. This is due to the gas inserted into your abdomen during the surgery. Lying down may help.
• Refrain from sex and lifting heavy objects until your surgeon allows you to.
• You may be allowed to shower two days after the surgery. However, avoid rubbing the area around the incision for at least one week, instead, gently pat the area dry.

There are no dietary restrictions after a tubal ligation reversal surgery. It is normal to get tired easily during the initial one to two weeks following the procedure. A majority of the women require two to three weeks before they can resume their normal routine. However, it may vary.

When to see the doctor?

You should contact the healthcare provider immediately if you experience any of the following symptoms at the site of the surgery:

• Redness, pain, or soreness around the incision site
• Drainage and bad odour from the incision site
• Chills
• Fever

Although it is rare to have complications after this surgery, it does carry the following risks:

• Infection
• Bleeding
• Breathing problems
• Allergic reaction to medicines
• Heart problems
• Pneumonia
• Ectopic pregnancy
• Inability to become pregnant
• Damage to nearby tissues or organs

The surgeon may ask you to visit one week after the surgery to examine your healing.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.