A new approach to tubal re-anastomosis in South Africa.
|Article Type:||Letter to the editor|
Laparoscopic surgery (Comparative analysis)
Laparoscopy (Comparative analysis)
Surgical anastomosis (Methods)
Surgical anastomosis (Research)
Tubal sterilization (Statistics)
Tubal sterilization (Methods)
Abdomen (Comparative analysis)
la Grange, Jane
van der Merwe, Kobie
|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|
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)
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(2.) Glock JL, Kim AH, Hulka JF, Hunt RB, Trad FS, Brumsted JR. Reproductive outcome after tubal reversal in women 40 years of age or older. Fertil Steril 1996;65(4):863-865.
(3.) Gupta I, Sawhney H, Mahajan U. Macroscopic tuboplasty: Reversal of female sterilization. Asia-Oceania J Obstet Gynaecol 1990;16(4):307-314.
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(5.) Hanafi M. Factors affecting the pregnancy rate after microsurgical reversal of tubal ligation. Fertil Steril 2003;80:434-40.
(6.) Stadtmauer L, Sauer V. Reversal of tubal sterilization using laparoscopically placed titanium staples: preliminary experience. Hum Reprod 1997;12(4):647-649.
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(8.) Bissonnette F, Lapensee L, Bouzayen R. Outpatient laparoscopic tubal anastomosis and subsequent fertility. Fertil Steril 1999;72:549-553.
(9.) Ribeiro S, Tormena R, Giribela C, Izzo C, Santos N, Pinotti J. Laparoscopic tubal anastomosis. Int J Gynecol Obstet 2003;84:142-146.
(10.) Petrucco O, Silber S, Chamberlain S, Warnes G, Davies M. Live birti following day surgery reversal of female sterilisation in women >40 years. Med J Aust 2007;187(5):271-273.
(11.) Yoon TK, Sung HR, Kang HG, Cha SH, Lee CN, Cha KY. Laparoscopic tubal anastomosis: fertility outcome in 202 cases. Fertil Steril 1999;72:1121-1126.
(12.) Hawkins J, Dube D, Kaplow M, Tulandi T. Cost analysis of tubal anastomosis by laparoscopy and by laparotomy. J Am Assoc Gynecol Laparosc 2001;9:120-124.
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