Pelviscopic reversal of tubal sterilization with the one- to two-stitch technique.

STUDY OBJECTIVE: To describe 28 pelviscopic proximal reversals of tubal sterilization.

DESIGN: Cohort study (Canadian Task Force classification II-2).

SETTING: University-affiliated hospital.

PATIENTS: Twenty-eight women.

INTERVENTIONS: Twenty-two women underwent bilateral and six unilateral tubal end-to-end anastomosis through a catheter introduced through the working channel of a hysteroscope for a combined hysteroscopic-laparoscopic operation.

MEASUREMENTS AND MAIN RESULTS: In the two-stitch technique the first stitch adapted the mesosalpinx and the second (4-0 or 6-0 material) to unite the tube muscularis. In some cases a third stitch was applied to either the muscularis or mesosalpinx. In all cases the wound was sealed with tissue col at the end of the procedure. Tubal patency was achieved in 95% of bilateral anastomoses and 100% of unilateral ones. Seventeen pregnancies (61%) were achieved within a minimum of 6 months and a maximum of 4 years. Fifteen patients (54%) had an intrauterine pregnancy with normal delivery and two (7%) had a tubal pregnancy. No abortions occurred.

CONCLUSION: Laparoscopic end-to-end anastomosis is a suitable surgical alternative to tubal end-to-end anastomosis by laparotomy and has all the advantages of a laparoscopic procedure.