Fertility outcomes of macroscopic tubal reanastomosis through mini-laparotomy: A retrospective case series study

Introduction: Tubal ligation reversal is a surgical option for restoring fertility, with outcomes influenced by technique, surgeon expertise, and patient factors. Objective: This study evaluates the fertility outcomes of macroscopic tubal reanastomosis through mini-laparotomy. Methods: This retrospective study analyzed medical records of women who had previously undergone tubal ligation either during cesarean sections or through laparoscopic electrocoagulation at a tertiary hospital in Türkiye between 2019 and 2022. The primary surgical approach involved a mini-laparotomy, and the anastomosis was performed macroscopically—without the use of an operating microscope—relying instead on direct visual inspection to access and reconnect the fallopian tubes. The suitability of the tubes for reanastomosis was assessed based on the length of the tubes, the presence of adhesion, and the condition of the fimbriae. Fertility outcomes, including live birth rates and time to conception, and surgical success rates, were measured. Results: The data of 23 patients were retrospectively reviewed. The surgical success rate was 78.2% (unilateral or bilateral reanastomosis of the tubas), with a pregnancy rate of 43.5% and a live birth rate of 34.8%. The mean time to conception was 3.73 months. Conclusion: Despite lower pregnancy rates compared with the broader literature, these outcomes are deemed acceptable, particularly for centers lacking facilities for more advanced surgical options. Therefore, macroscopic tubal reanastomosis through mini-laparotomy emerges as a feasible alternative for surgeons with limited experience in more intricate microsurgical techniques, providing a viable pathway to restoring fertility with reasonable success.