Document Detail

Microsurgical reversal of sterilisation - is this still clinically relevant today?
MedLine Citation:
PMID:  20126810     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: Women with previous tubal sterilisation seeking fertility are faced with treatment options of reconstructive tubal surgery or in vitro fertilisation (IVF) techniques. The aim was to assess the current viability of tubal anastomosis in a local clinical practice. MATERIALS AND METHODS: A retrospective cohort review of all sterilisation reversal cases from January 1998 to January 2008. The main outcome measures included fi rst pregnancy success and live birth after surgery. Subsequent live births, ectopic pregnancies, miscarriages, duration of surgery and hospitalisation within the study period were also reported. We included cases aged less than 40 years, without any known semen abnormalities, and performed by only one operator. Cases with only unilateral reversal were excluded. RESULTS: Nineteen cases with previous Filshie clip ligation (9 laparoscopic/10 open) were reviewed. Cumulative pregnancy rates with surgery were 47.4% (<6 months), 57.9% (6 to 12 months), 68.4% (12 to 48 months) and 73.7% (>48 months). Pregnancy (77.8% vs 70.0%) and live birth rates (66.7% vs 60.0%) were similar between laparoscopy and open surgery. The mean interval to pregnancy was marginally lower via laparoscopy (11.3 vs 13.6 months). Hospitalisation stay was significantly halved (1.43 vs 3.00 days) but ectopic pregnancies were increased 3-fold (3 vs 1) with laparoscopy. Compared with IVF, the estimated average cost per delivery for laparoscopic reversal was reduced for laparoscopic reversal with no multiple pregnancies. CONCLUSION: Our results favour surgical reversal after sterilisation for patients younger than 40 years old. It avoids hyperstimulation risks and the economic burdens associated with multiple pregnancies. Where expertise is available, laparoscopic reversal should be performed.
Heng Hao Tan; Seong Feei Loh
Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Annals of the Academy of Medicine, Singapore     Volume:  39     ISSN:  0304-4602     ISO Abbreviation:  Ann. Acad. Med. Singap.     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2010-02-03     Completed Date:  2010-05-24     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7503289     Medline TA:  Ann Acad Med Singapore     Country:  Singapore    
Other Details:
Languages:  eng     Pagination:  22-6     Citation Subset:  IM    
Reproductive Medicine Department, KK Women's and Children's Hospital, Singapore.
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MeSH Terms
Age Factors
Cohort Studies
Fertilization in Vitro
Laparotomy / adverse effects
Microsurgery / methods*
Pregnancy Rate*
Pregnancy, Ectopic / etiology
Retrospective Studies
Sterilization Reversal / adverse effects*
Sterilization, Tubal*

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