DATE: September 30, 2020
CATEGORY: Tubal Reversal
Dr. Turner and I close the fallopian tube in two layers instead so they are not just sewn together but are also sewn open. The fallopian tubes have a central channel where the sperm from the male travels to the ovary where it fertilizes the egg and the fertilized egg travels back to the uterus to grow into a baby. When a woman has a tubal ligation of any type, including the implementation of Essure devices, the central channel becomes blocked. Sperm cannot get to the egg to fertilize it so there are no fertilized eggs to grow into a baby.
Imagine, if you will a roll of toilet paper with a central cardboard tube so you can install the roll on the dispenser in your bathroom. If you cut across a fallopian tube and looked at it under a microscope, the various layers are similar to the toilet paper roll. Most tubal reversal surgeons sew the tube together around the outside in a single layer, sometimes using a removable stent to line up the central channel while they sew around the outside. The problem with that technique is once the stent is removed, there is nothing to keep the two central channels together. With our technique, the central channel is sewn open first with 6 very tiny sutures and the outside is then sewn in a second layer sewing this critical part open as well as together. Every expert agrees that you should use a very small suture to do tubal reversals because the tubes are very small. The sutures we use in the inner layer are so thin that if you throw one up in the air they will float. When I was taught how to do reversals I had to wear a surgical mask when I practiced sewing because if I sneezed the practice suture will go across the room. The downside of these very tiny sutures that we use is that they don’t add enough strength, using two layers gives strength to the tubes so they cannot fall apart. The inner layer is called the muscularis because it has muscle fibers to make the tube contract and relax to help the fertilized egg get into the womb to grow into a baby. This action of the inner muscle layer is another reason to make sure it is aligned up perfectly to help the fertilized egg along its way to the womb. The central channel in a woman’s fallopian tube can be as small as the ball in a ballpoint pen. Working at his sort of dimension requires magnification and a steady hand.
The way we do our reversals is more expensive for us but we feel it is better. We have no argument with others that do differently