I need a tubal reversal procedure  called tubouterine implantation to remove coils : do you do that surgery?


Tubouterine implantation to remove coils can be done,  but the success rates depend upon the depth the coils were inserted
- for an istmo-isthmic reanastomosis :  over 80%
- for a isthmo-cornual reanastomosis : 50%
- for a deep intramural reimplantaion < 20%  (and thus IVF becomes preferable)

One of the problems with tubal sterilisation is informed consent which cannot be given by the patient , without the following information (to be given by the surgeon.)  The surgeon indeed should mention all alternative techniques and not only the one he performs.
1. Yoon Ring and Hulka clip sterilisation are normally “reversible” with an isthmo-isthmic tubal reanastomosis either by microsurgery either by laparoscopy. If the sterilisation is not performed mid-isthmic, -as should be done- success rates of isthmo-ampullary or isthmo-cornual reanastomosis are much lower.
2. Ring or clip sterilisations can be done under local anaesthesia with an hospitalisation of 3 hours.
3. Extensive coagulation, ampullectomy (Pomeroy) or hysteroscopic coils are considered non-reversible types of sterilisation. This is important since nobody knows what the future will bring.

The issue of reversibility remains debated since a tubal sterilisation should be considered definitive, thus requiring extensive counseling. Reversibility however can be compared to a live insurance which is not taken with the intention to die.

Anyway, the risk of regretting a sterilisation, is well known to increase when the patient is younger or has no children.

Professor P.R.  koninckx

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