A new approach to tubal re-anastomosis in South Africa.
Article Type: Letter to the editor
Subject: Laparoscopic surgery (Statistics)
Laparoscopic surgery (Comparative analysis)
Laparoscopy (Statistics)
Laparoscopy (Comparative analysis)
Anastomosis (Methods)
Anastomosis (Research)
Surgical anastomosis (Methods)
Surgical anastomosis (Research)
Tubal sterilization (Statistics)
Tubal sterilization (Methods)
Abdomen (Surgery)
Abdomen (Statistics)
Abdomen (Comparative analysis)
Authors: la Grange, Jane
Kruger, Thinus
van der Merwe, Kobie
Siebert, Igno
Viola, Maria
Matsaseng, Thabo
Pub Date: 05/01/2011
Publication: Name: South African Journal of Obstetrics and Gynaecology Publisher: South African Medical Association Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2011 South African Medical Association ISSN: 0038-2329
Issue: Date: May, 2011 Source Volume: 17 Source Issue: 2
Topic: Event Code: 680 Labor Distribution by Employer; 310 Science & research
Geographic: Geographic Scope: South Africa Geographic Code: 6SOUT South Africa
Accession Number: 257675224
Full Text: To the Editor: Contraception by means of fallopian tube sterilisation is the most common method used worldwide, and it is estimated that on average 138 million women of reproductive age are sterilised globally each year. Several studies have indicated that the incidence of tubal re-anastomosis in previously sterilised women is 1-2%. (1) Laparotomy is currently seen as the gold standard for fallopian tube reversal, and this was the case at Tygerberg Hospital from 1982. However, laparoscopy has been extensively explored as a viable alternative over the past 3 decades. This technique requires expert endoscopic surgical skill. Recently laparoscopy was instituted as a reversal method at our facility owing to our interest in endoscopy.

Between January 2007 and December 2009, 27 patients at Tygerberg Hospital were identified who requested tubal re-anastomosis and fulfilled the admission criteria: 19 received a laparoscopy and 8 a laparotomy. All the patients had hysterosalpingograms from 3 months onwards. Overall patency figures of 78.9% (15/19) for laparoscopy and 75% (6/8) for laparotomy were achieved.

Post-reversal tubal patency as determined by hysterosalpingography has been reported in eight international reanastomosis projects. (2-9) Mean patency in the laparotomy and laparoscopy groups was 69.9% and 69.2%, respectively. Our small series compares favourably with the international data outlined. The literature indicates that post-anastomosis pregnancy rates after laparotomy range from 40% to 91.6%. (4,10) Pregnancy rates achieved in studies evaluating success of laparoscopy ranged from 31.2% to 82.2% (7,11) (mean 57.8%). The laparoscopic approach offers numerous advantages for the patient, with a shorter hospital stay and less discomfort and possibly lower cost. (12)

With this letter we are informing our colleagues that the laparoscopic alternative for reversal could be offered to patients when experienced endoscopic surgeons are available.

Jane la Grange, MB ChB

Thinus Kruger, MB ChB, MPharmMed, MMed (O&G), FCOG (SA), MD, FRCOG

Kobie van der Merwe, MB ChB, MMed (O&G), FCOG (SA)

Igno Siebert, MB ChB, MMed (O&G), FCOG, PhD

Maria Viola, MB ChB, Specialist (O&G), University of Buenos Aires, Argentina

Thabo Matsaseng, MB ChB, MMed (O&G), FCOG (SA)

Department of Obstetrics and Gynaecology, Stellenbosch University, Tygerber g, W Cape

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