By Lisa Rogers, M.D.
Have you ever made a decision that you thought was right, only to realize later that you wish you could undo it? We all do that from time to time, usually about a trivial matter. However, some women have had their tubes tied, only to realize later that it was the wrong decision. This is where tubal anastamosis, or tubal reversal, can be the answer.
Tubal anastamosis is a surgical procedure that reconnects the tied ends of the fallopian tubes and can restore a woman's ability to become pregnant. Dr. John Curlin, who recently retired after a distinguished career in obstetrics and gynecology, perfected the technique of tubal anastamosis. He realized that many women regretted the decision to have their tubes tied, either because of a change in their lives or feeling that it was wrong to prevent a pregnancy that God may have intended for them. There are many different reasons why women seek to have their tubal ligation reversed.
In January of 1997, I began operating with Dr. Curlin to learn his method of tubal reversal, and have now taken over that part of his practice since his retirement. Dr. Curlin has worked with Jackson Madison County General Hospital to provide a price package that keeps costs at a minimum. Women come from all across the country (even Alaska and Hawaii) to have their surgery done here in Jackson.
There are several different ways to perform a tubal ligation (surgery done to prevent pregnancy). The surgeon can put clips or bands on the tubes, tie the tubes with sutures and remove a portion of them, or burn through the tubes with electrical energy, or cautery. In a tubal reversal, the ends of the tube that are remaining after ligation are sewn back together. Unless an excessive amount of tube was destroyed at the time of tubal ligation, there is usually enough tube to sew back together. At least four centimeters of tubal length is thought to be necessary for the tube to function as it should. In addition to tubal length, it is also essential that the fimbria of the tube is intact. The fimbria is the end of the fallopian tube that is closest to the ovary; it resembles a flower. The fimbria works to pick up the egg after it is released from the ovary during ovulation. In most cases, the fimbria is not removed at the time of tubal ligation.
The records from the tubal ligation procedure are obtained and reviewed carefully before the reversal is done to see how the tubes were tied and how much of the tube was removed, if any. During the tubal reversal procedure, the tied ends of the tube are opened and then sewn together in two layers using 8-0 vicryl sutures. An operating microscope and microsurgical instruments are used so that the tiny sutures can be placed in the best location to restore the patency of the tube. Blue dye is then injected into the uterus so that it flows through the tubes to verify that they are open. The surgery usually lasts from 1 1/2 to 2 hours, and the hospital stay is usually 12 to 24 hours. Most patients are able to return to work within two weeks. The sutures used are all absorbable, so no suture removal is necessary. The incision is low in the abdomen, and is covered with a clear tape dressing that is removed seven days after surgery.
There is an increased risk of ectopic, or tubal, pregnancy after tubal anastamosis. After an egg is fertilized by a sperm, the tiny embryo that is formed has to move through the fallopian tube into the uterus. After a tubal ligation and then a reversal, there can be scarring inside the tube that can cause the embryo to get stuck and then grow inside the tube. Therefore, it is mandatory that early prenatal care is sought after a tubal reversal, so that blood tests and ultrasounds can be done to assure that the baby is growing inside the uterus as it should be. Otherwise, there is no increased risk of pregnancy complications after a tubal reversal. I do recommend that anyone who is trying to become pregnant take folic acid, or folate, to lower the risk of having a baby with spina bifida. To provide the benefit, the folic acid has to be taken before a woman becomes pregnant.
If you would like more information on tubal reversals, you can log on the Jackson Clinic website at www.jacksonclinic.com and then click on "tubal reversals." You may also call my nurse at the Clinic, Cindy Rawdon, at (731) 660-8300.
Lisa Williams Rogers, M.D., of the Jackson Clinic, received her undergraduate degree from Union University in Jackson, Tennessee, and her medical degree from the University of Tennessee in Memphis. While in medical school, she received the surgery award for her class. Her residency in obstetrics and gynecology was completed at the University of Mississippi Medical Center in 1991. After completing her residency, she joined The Jackson Clinic. She is board certified by the American Board of Obstetrics and Gynecology and a Fellow of the American College of Obstetricians and Gynecologists. She is also a member of the American Association of Pro-Life Obstetricians and Gynecologists and the Baptist Medical and Dental Fellowship.