Tubal Ligation Reversal

1. Tubal ligation reversal (TLR) is a surgical procedure done to re-open fallopian tubes or reverse any type of tubal ligation.
2. Tubal ligation or tubal sterilisation is a method of contraception where a woman’s fallopian tubes are clipped or ligated.

The benefits of Tubal Ligation reversal  help in 

1. Restoring fertility in women

TLR is done for women who have previously undergone tubal sterilisation or tubectomy. 

1. This surgery provides women with the option to get pregnant. 
2. Factors that influence the surgeon’s decision and patient selection are: 
3. Patient's age and body mass index
4. The type of tubal ligation
5. The extent of the damage to the fallopian tubes
6. Remaining length of the fallopian tubes
7. Other fertility factors, such as sperm and egg quality, determine the chances of getting pregnant after the tubal ligation reversal.

Procedure description

1. Tubal ligation reversal is a laparoscopic procedure. But rarely, it may be performed as an open laparotomy.
2. Initially, two small cuts are made on either side of the umbilicus, at the bikini line. 
3. Laparoscopic instruments, which consist of a camera, a light source, and other surgical tools, are inserted into the patient’s pelvis through these cuts.
4. The surgeon decides if the ends of the fallopian tubes can be attached again. 
5. Depending on the previous surgery, the surgeon will either remove the clips/rings or connect the ends of the fallopian tubes with sutures. 
6. Once the tubes are reconnected, the surgeon will inject a dye into one end of each tube. If no dye leaks out, that means the tubes have been reattached successfully.

What to expect before surgery 

1. Since a tubal ligation reversal is primarily done so that the patient can get pregnant again, a full assessment is made about the likelihood of success and the patient’s ability to get pregnant after the procedure.
2. Basic blood work, physical fitness for surgery, along with fertility tests for both partners are done before proceeding with the surgery.
3. The patient’s medical history and complete surgical notes from the previous surgery are examined.
4. A PAC (pre-anaesthetic checkup) is done to check the patient’s fitness to tolerate anaesthesia. The anaesthetist and the surgeon decide if the patient is fit for a general anaesthesia or the procedure needs to be done under spinal anaesthesia.
5. A complete list of the medications that the patient is currently on is noted down. They are informed if any medication needs to be stopped or increased in dose.
6. A date for the surgery is decided based on the clearance of the above tests and checkups. 
7. The patient is generally asked to fast for 6 to 8 hours before surgery.
8. Tubal ligation reversal is not covered under medical insurance, so patients have to pay for it out of their pocket. 
9. Depending on the surgery and recovery, the patient has to stay in the hospital for 1 to 3 days.
10. The patient can reach out to the surgeon for any additional queries.

What to expect on the day of the surgery 

1. After being admitted for the surgery, the patient and their kin have to sign a consent form. This explains in detail the surgery and the associated risks of any complications or adverse outcomes of the surgery.
2. The patient is made to change into a hospital gown. Any jewellery, dentures, or other items are removed.
3. The patient’s pubic hair is shaved, and the area is prepped for the surgery.
4. The patient is shifted from the pre-op area to the operation theatre.

What to expect during the surgery?

1. TLR usually takes 2-3 hours.
2. The patient lies on their back and is given IV lines to receive medicines and IV fluids before, during, and after the procedure.
3. The surgical site is cleaned with spirit and betadine and then draped with an
4. aseptic cloth.
5. After this, the anaesthetist will administer the anaesthesia while monitoring the patient carefully. 
6. In case of general anaesthesia, the patient is completely unconscious during the duration of the surgery, but if given spinal anaesthesia, the patient is awake during the surgery but anaesthetized below the waist. 
7. The patient’s vitals, such as pulse, respiratory rate, blood pressure, etc., are continuously measured during the procedure.
8. The surgeon makes tiny incisions in the suprapubic area for the insertion of the laparoscopic instruments and then examines the fallopian tubes.
9. After that, either the clips/rings are unclipped or the ends of the fallopian tubes are sutured together and the surgery is finished.

What to expect after the surgery? 

1. Following the surgery, the patient is made conscious again and moved to a recovery room.
2. The patient is monitored for their vitals, any post-surgical complications, and the wearing off of anaesthesia.
3. The patient is given pain medication and prophylactic antibiotics for the pain and tenderness at the incision site.
4. Recovery from TLR usually takes one to two weeks.
5. Patients are given the following advice: 
6. - Wait 48 hours to bathe after surgery.
7. - Don’t rub the incision; pat on it gently.
8. - Eat a high-fibre diet to avoid constipation.
9. - Avoid heavy lifting or strenuous activity.
10. - No sexual activity for the duration prescribed by the doctor.
11. - Any previous medication that was stopped should only be resumed after   consulting with the doctor.

First follow-up appointment 

The first follow-up appointment after being discharged is after one week.

When to consult a doctor 

There are complications and adverse outcomes with tubal ligation reversal as with any surgery. 

1. The biggest risk involved with TLR is ectopic pregnancy. It is when a fertilised egg implants outside the uterus, which is most often the fallopian tubes. It is a serious complication and life-threatening without treatment. 
2. The success rate for pregnancy after TLR is around 50-80%. Despite a successful TLR, a patient might be unable to get pregnant. It depends on the age of the patient, what type of previous tubal sterilisation surgery was performed, and the condition of the remaining fallopian tubes. 
3. There can be infection, bleeding, anaesthesia-related complications or injury to nearby organs.
4. Scarring of the fallopian tubes might also be a complication following the procedure.