Microsurgical reconstruction of the uterin tube in sterilized patients.

ABSTRACT

PIP: The most frequent reason given for requests for tubal reconstruction has been divorce followed by a desire to produce children with a new spouse. Methods of nonmicroscopic tubal reconstruction have had frequent failures due to surgically induced distortion and damage to physiologic function. Microsurgery minimizes these adverse effects. A doubled subsequent pregnancy rate has resulted. Patency, as determined by hysterosalpingography between 3-6 months postoperatively, was improved from 50% in gross surgery operations to 91.7%. About 50% of those requesting tubal reconstruction have been rejected, usually because too much tubal damage had been done by the previous sterilization operation. Microsurgical technique requires use of the binocular operating microscope. Loupe lenses are not adequate. The suture material is 10-0 Ethilon, a black monofilament nylon. Several special instruments are also needed. Further details of the technique employed are given. Greater caution against injudicious sterilization is advised. Only reversible types of sterilization operations are recommended. When surgical reversal is indicated, microsurgery offers the best hope of success.