Information About Tubal Reversals
Tubal ligation is a generic term used to refer to several different types of procedures to interrupt the fallopian tubes in order to prevent pregnancy. In the true sense of the word, a ligation is a procedure in which the tubes were tied with suture. The various types of tubal interruption procedures are described here.
- Post-Partum Tubal Ligation - this is a procedure performed just after delivery or during a cesarean section. During this procedure, the surgeon takes a portion of the fallopian tube out after securing the blood vessels with suture. There are several techniques for this type of tubal ligation. The names of these techniques include a modified Pomroy and a Parkland. Less common techniques include an Irving, or a Uchida tubal ligation. The exact differences are more of technical interest and don't make much difference except in the case of the less commonly performed procedures.
- Tubal fulguration - This type of procedure is performed laparoscopically in most cases. An electromagnetic current is used to "burn" the fallopian tubes. When the tube heals, there is a gap in the middle portion of the fallopian tube. Some surgeons will cut the burned segment to verify the tube is completely burned. There is debate over the necessity of this extra cutting step. Often-times, patients are told their tubes were cauterized. Cautery is not an accurate description in this setting but it is fair to say the result - burning of the tubes - is essentially the same. Some patients are also told their tubes were "cut, tied, and burned". The duration of "burning " and the amount of tube that was destroyed is the most important factor when considering tubal reversal surgery.
- Fallopian rings - This procedure involves the placement of stretchable bands around the mid-portion of the fallopian tube. The tube is constricted by the bands and dies. Simply removing the bands will not restore the tube to normal function. This procedure tends to destroy less of the fallopian tubes and lends itself to an easier reversal procedure in most cases.
- Clips - The most common type of clips used are Hulka clips. These are clamp-type devices that are compressed on the fallopian tube. In an effort to reduce the chance of failure, many surgeons will place multiple clips on the tube. If applied properly, a single clip in the middle of the fallopian tube is adequate for contraception. Properly placed clips are also fairly easy to reverse in most cases.
- Essure - This is a fairly new technique of inserting a Dacron containinig coid within the fallopian tube. Scar tissue usually invades into the coil and becomes densely attached to the Dacron. These coils can not easily be removed. Generally, a tubal reversal will not adequately correct the damage caused by an Essure. The portion of the coil protruding into the uterine cavity may cause a problem with a pregnancy conceived through In Vitro fertilization. There are instances where pregnancy has been possible using IVF.