Reversal After Laparoscopic Sterilisation- A Practical Approach

Abstract

BACKGROUNDFemale sterilisation has been widely accepted in India especially after the availability of endoscopic ligations and even the couples with low parity have started opting for it. As per ministry of health records, 46 lakh tubectomies were performed as against 1.79 lakh vasectomies between 2011 and 2012. Success of national sterilisation programme is possible only with universal availability of reversal procedures in the fast changing present day social scenario. The aim of the study was to find an easy and practical approach for reversal after laparoscopic sterilisation and to devise an easy and universally available reversal procedure for the providers of sterilisation services. MATERIALS AND METHODSTwenty-five females presenting in OPD for reversal of laparoscopic sterilisation were counselled and operated abdominally using 4x magnification with a simple technique after ruling out infection under regional anaesthesia, i.e. combined spinal and epidural technique. The tissues were continuously irrigated with heparinised ringer lactate. RESULTSThe common reason for reversal was death of one or more children in twenty cases. Other reasons for reversal were sickness of living children in two cases and remarriage in three cases. Patency was observed in all twenty-five cases at the time of operation. 16 (64%) females conceived within 1-4 years. Out of these 14 (56%) were term pregnancies and 2 (8%) ended in abortions. 4 (16%) did not conceive, whereas 2 (8%) were lost to followup. The result of 3 (12%) is still awaited. The type of anastomosis performed was isthmo-isthmic in 16 (64%) with 9 term pregnancies and 1 abortion. 4 (16%) were isthmo-ampullary with 2 term pregnancies and 2 with isthmo-interstitial cases had 2 term pregnancies. Combination of cornual implantation and isthmo-isthmic anastomosis in 1 case had a term pregnancy and 2 with combination of isthmo-isthmic and isthmo-ampullary anastomosis had 1 abortion. CONCLUSIONThe simplicity of the procedure, acceptable pregnancy rates and cost effectiveness as compared to IVF can contribute to benefit the masses especially located in remote areas and without the facility of latest techniques.