Explain: Tubal Reverse

Content:

Type of Operation:

Clinical Information:

The year-old woman was admitted for tubal reanastomosis because of [[previous tubal ligation, tubal occlusion]], which was shown by [[history, HSG, Laparoscopy, Other]]. The procedure on the right tube was {{ Isthmic-Isthmic, Isthmic- Ampullary, Ampullary – Ampullary, Cornual - Isthmic }} anastomosis, and the left was {{ Isthmic-Isthmic, Isthmic- Ampullary, Ampullary – Ampullary, Cornual - Isthmic }}. In addition, [[Lysis of adhesion, Fimbrioplasty, Electrocauterization of endometriosis, Plication of uterosacral ligament, LUNA, presacral neurectomy, Incidental appendectomy]] was/were also performed.

Operative Procedures:

The woman was brought to the operating room and placed in supine position on the operating table. General anesthesia was performed through endotracheal intubation. Prophylactic antibiotics was given immediately before the operation. The abdominal wall was sterilized with soap solution and alcohol betadine and the vagina and cervix with aqua betadine and intrauterine foley was also placed. The pelvic cavity was accessed through a phannestial abdominal wall incision. The intestinal loop was placed up to the abdominal cavity and the uterus and adnexae were exposed. The adhesive lesions were removed by simple excision and the rough area were repaired by 3-O chromic catgut. Some small lesions were electrocauterized. Zeiss OPM 1-7 operating microscope with microsurgical instruments, a microelectrode monopolar and/ or bipolar cauter were used. An assortment of Teflon rods was used for gentle manipulation of tubes and ovaries. The proximal portion of the fallopian tube is identified and its occluded tip resected. A No. 2-O nylon suture of 100 cm is introduced into the lumen with fine forceps. Approximately 60 cm of No. 2-O nylon may be threated through the tubal lumen and placed within the uterine cavity. The same procedure was carried on the opposite site. The distal obstructed end is resected and the No. 2-O nylon is then passed through the oviduct and out the fimbriated end. The mesosalpinx is carefully approximated to eliminate tension at the anastomotic site. The lumens of the two ends are then approximated with No. 9-O on the 3-6-9-12 o'clock position. The needle is passed only through the muscular of the proximal tube and through the muscular of the distal segment. The sutures are tied securely, and second layer of the additional sutures is placed to approximate the tubal serosa with 7-O nylon. The No. 2-O nylon can be easily removed through the fimbria. The abdminal wall was closed layer by layer and the skin was approximately by 3-0 Vicryl subcutaneously. The patient stood the procedure well and was emerged from the anesthesia and sent to the recovery room in stable condition.