Reversal of sterilization by macrosurgery / conventional surgery with microsurgical principles with special reference to rail road technique: an overview of success and failures

Abstract

Objectives: The present study undertaken to assess the efficacy of technique of reversal of sterilization by macrosurgery with microsurgical principles and use of rail road technique for cornual - isthmic anastomosis and factors truly influencing the success rate. Methodology: The present study is retrospective observational study of 142 women who underwent reversal of sterilization. Railroad technique was done in 25 cases where tubal ligation was either done at cornual end or isthmic region very close to uterus where tubal lumen is very narrow. Out of these 142 cases 78 patients could be followed. Various factors were studied which were responsible for success and failure of surgery in these 78 cases. Results: Out of 142 cases of reversal, 78 (54.93%) patients could be followed and in these 78 cases 52(66.67%) patients had intrauterine pregnancy. The factors that influenced the success rate were age of the patient when it was < 30yrs success rate 42 (81%). When sterilization reversal interval was less than 3yrs. Success rate was 31(80%). Residual length of the tube more than 5cm success rate was 84.61%. Out of 4 women of isthmico - interstitial anastomosis 3 women conceived in whom railroad technique was adopted. Conclusion: The intrauterine pregnancy rate is 66.67%. Success rate depends on age of the patient it was 81% in patients < 30yrs. Success in reversal following laparoscopic sterilization was 86.67%. When residual length of the tube at conclusion of surgery was more than 5cm the success rate was statically significant more. The technique is simple, easily learnt, inexpensive method of reversal with good and comparable results to microsurgery or laparoscopic reversal.

Keywords

• reversal of sterilization
• rail road technique of reversal
• pregnancy rate
• cornual- isthmic anastomosis