Today we had to perform a surgery on a young lady of about thirty years old. She had delivered two male children earlier, but since her husband divorced her she married a man who is a widower with no children. Her husband had taken away the two kids branding her as a mental woman. Now after nine years of living together with this man she planned to have a child. They live in the north of Tamilnadu.
Female sterilization is an everyday procedure and is currently the most popular form of birth control in India. All these sterilizations are nowadays performed in young women of low parity thinking that family is complete. However due to unforeseen circumstances, however such a woman may seek reversal due to unforeseen events such as death of the only male child or undergoing a second wedlock. 1-3% of these women subsequently demand reversal of sterilization.
Routine investigations like for a major surgery was done. a preoperative diagnostic laparoscopy to assess the site of block, exclude multiple blocks and to rule out tuberculosis were performed. Semen analysis of the husband was also done. Patient was called for surgery to be performed between 7th and 10th day of the menstrual cycle.The informed consent was taken from all patients after a detailed counseling of both husband and wife.
The occluded segment of the tube was resected till there was complete excision of pathological tissue. Precise alignment of tissue planes using atraumatic technique was carried out by prolene (monofilament polypropylene) 8-0, mounted on a spatulate tipped round-bodied atraumatic needle or a round body micro needle. For end to end tubal anastomosis, four sutures at 12', 6', 3' and 9-O clock were taken in the muscularis layer and serosa. Mucosa was avoided. Sutures were taken in such a way that knots faced the serosa. The patency was assured intra-operatively by methylene blue injection. Abdomen was closed in layers after a thorough peritoneal lavage.
The sutures will be removed on the seventh day. She will have to report back after three months to assess the patency of the tubes.
Just keeping my fingers crossed that she will conceive again. The probable complication may be a tubal pregnancy.