Pelvic Adhesions and Tubal Damage

If pelvic adhesions are found at laparoscopy and minimal access tubal surgery is performed, then 35% were pregnant at 12 months and 58% at 24 months. {Reference Number 4}. If the internal tubal structure was normal then pregnancy rates of 71% at 33 months have been reported after laparoscopic surgery, {Reference Number 5}. The outcome after day case laparoscopic tubal surgery has been shown to be statistically superior to that after open microsurgical tubal reconstruction (57% versus 36% at 12 months follow up). {Reference Number 6}

Example of severe Adhesions from the Abdomen to the Womb after Caesarean Section

Laparoscopic Tubal Surgery (unblocking of the tubes) Reversal of Female Sterilisation

A case of the right tube damaged by previous sterilisation, showing the 2 separate ends of the tubes with the white ovary beneath.

The open end of the tube closest to the womb is seen after the blockage has been dissected out.

The blue dye is injected through the cervix and can be clearly seen spilling out.

The 2 ends of the tube have been stitched together with very fine (similar to the diameter of a human hair) blue stitches around a green plastic catheter that aligns the tube and temporarily holds it open to aid healing.

The same approach to laparoscopic tubal surgery with laparoscopic suturing provides day case operations with equally good pregnancy rates to laparotomy (Open Operation) for reversal of female sterilization, with reported pregnancy rates of 77.5% at 12 months, {Reference Number7}

Blocked tubes and Ectopic pregnancy Risk

These same green catheters with a very fine titanium guide wire are also inserted through the cervix (neck of the womb) under a general anaesthetic and via a laparoscopy as above can be guided to unblock the tubes. The woman wakes up once the tubes are repaired. However like anything else, once something is repaired it is not necessarily as good as new, and although good pregnancy rates are obtained, an early scan is required to make sure that the pregnancy has not got stuck in the tube, (a risk of between 5 to 40%). In this case it is removed as a day case key hole operation.