[Microsurgical desterilizations. Reflections on 65 cases].

Sixty-five patients were operated on for reversal of sterilization between the 1st January 1978 and the 1st January 1984, with a follow-up of longer than 20 months. All had at least one tube which had a healthy distal and ampullary portion. Sterilization had been carried out in 54 cases by laparotomy (31 at caesarean operation) and they represented 83% of the cases, and laparoscopically in 11 cases. Laparotomy is still the most frequently used method to sterilise women in France; but it is to be hoped that in the future it will be superseded by laparoscopy which is less traumatising and allows the use of more conservative methods. The pathological study that was carried out on the segments of tube that were removed during the reversal operation showed that they were usually normal or had only very limited abnormalities (44.7%). When there were lesions these were usually in the proximal isthmic portion, where in 23% of cases there were diverticula or in 10.7% of cases epithelial atrophy. Fifty one out of the 65 patients had an intra-uterine pregnancy that carried to term and this was a success rate of 78.5%. There were four ectopic pregnancies (6.1%). The success rate did not seem to depend at all on the way the sterilization had been carried out except that it seemed that we had greater success in cases where the resection had been cornual. There seemed also to be no difference no matter how long a time interval had occurred from the sterilization to the reversal operation, the site of the anastomosis and the histological appearance of the fragments of the tube that were sent for section. This similarity in results seems to us to depend on using micro-surgical techniques which allow precise resection of pathological portions of the tube and a perfect anastomosis in a healthy zone of the tube.