Microsursugical Tubal reanastomosis (Tubal reversal)
Tubal ligation reversal involves·microsurgical techniques·to open and reconnect the·fallopian tube·segments that remain after a tubal ligation procedure.·Usually there are two remaining fallopian tube segments – the proximal tubal segment that emerges from the uterus and the distal tubal segment that ends with the fimbria next to the ovary.
The procedure that connects these separated parts of the fallopian tube is called microsurgical tubotubal anastomosis, or tubal anastomosis for short.·Often many refer to the tubal anastomosis procedure as “tubal reversal”, and can provide an alternative to in-vitro fertilization.
After opening the blocked ends of the tubal segments, a narrow flexible stent is gently threaded through the fallopian tube segments and into the uterine cavity. This ensures the fallopian tube is open from the uterine cavity to the fimbrial end. The newly created tubal openings are then drawn next to each other by placing a suture underneath the fallopian tube segments. The retention suture keeps the tubal edges together, decreases tension, and avoids the likelihood of the tubal segments subsequently pulling apart.
Very fine, permanent microsurgical sutures are used to precisely align the muscular portion (muscularis) and outer layer (serosa), while avoiding the inner layer (mucosa), of the fallopian tube. The tubal stent is then gently withdrawn from the fimbrial end of the tube.
The use of permanent non-absorbable sutures is very important because it allows the tubal edges to heal together and avoids tubal scarring which may occur when temporary no-absorbable sutures are used.
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