Objective: To compare efficacy of sterilization reversals by laparotomy versus laparoscopy. Design: Meta-analysis. Search Strategy: Electronic searches were carried out for randomized controlled trials and retrospective and prospective clinical studies. Search engines such as PubMed, Science Direct, Medline and the Cochrane database were made use of. Our restrictions were English human studies published from 1989 to January 2010. Interventions: Microsurgical tubal reanastomosis performed comparing laparoscopy with laparotomy using a microsurgical technique. Outcome Measures:Primary: overall pregnancy rates, including positive clinical pregnancy, intrauterine and ectopic pregnancy rates. Secondary: surgery time. Results: Three retrospective comparative studies were retrieved from international data that investigated laparotomy versus laparoscopy. A total number of 184 patients were included, 88 and 96 respectively undergoing laparoscopy and laparotomy. Pregnancy rates achieved by laparoscopy ranged from 65 to 80.5% (mean 74.43%) and by laparotomy from 70 to 80% (mean 71.33%). A subanalysis of two of the three comparative studies show that laparoscopy reversal surgery requires a statistically significant longer operative time than does laparotomy (p < 0.00001). Conclusions: There is no difference between the laparoscopy and laparotomy approach to tubal reanastomosis when regarding overall pregnancy rates, intrauterine and ectopic pregnancy rates.

1.
Yossry M, Aboulghar M, D’Angelo A, Gillet W: In vitro fertilisation versus tubal reanastomosis (sterilisation reversal) for subfertility after tubal sterilisation. Cochrane Database Syst Rev 2006;3:CD004144.
2.
Van Voorhis BJ: Comparison of tubal ligation reversal procedures. Clin Obstet Gynecol 2000;43:641–649.
3.
Trussel J, Guilbert E, Hedley A: Sterilization failure, sterilization reversal, and pregnancy after sterilization reversal in Quebec. Obstet Gynecol 2003;101:677–684.
4.
Biswas A, Mondal A: Evaluation of women undergoing sterilisation reversal and subsequent pregnancy outcome. J Indian Med Assoc 2006;104:183–185.
5.
Gomel V. Tubal reconstruction by microsurgery. Fertil Steril 1977;28:59–65.
6.
Sedbon E, Bouquet de Jolinieres J, Boudouries O: Tubal desterilization through exclusive laparoscopy. Hum Reprod 1989;4:158–159.
7.
Swolin K: Fertilitats operationen. Acta Obstet Gynecol Scand 1967;46:234–268.
8.
Garcia CR, David A, Brackett BG: Effects of microsurgical removal of the rabbit uterotubal junction. Fertil Steril 1969;20:250–257.
9.
Koh CH, Janik GM: Laparoscopic microsurgical tubal anastomosis. Gynaecologic operative endoscopy. Obstet Gynecol Clin North Am 1999;26:189–200.
10.
Kaloo P, Cooper M: Fertility outcomes following laparoscopic tubal re-anastomosis post-tubal sterilisation. Aust NZ J Obstet Gynaecol 2002;42:256–258.
11.
Yoon T, Sung H, Cha S, Lee C, Cha K: Fertility outcome after laparoscopic microsurgical tubal anastomosis. Fertil Steril 1997;67:18–22.
12.
Bissonnette F, Lapensee L, Bouzayen R: Outpatient laparoscopic tubal anastomosis and subsequent fertility. Fertil Steril 1999;72:549–553.
13.
Degueldre M, Vandromme J, Huong P, Cadière G: Robotically assisted laparoscopic microsurgical tubal reanastomosis: a feasibility study. Fertil Steril 2000;74:1020.
14.
Cha SH, Lee MH, Kim JH, Lee CN, Yoon TK, Cha KY: Fertility outcome after tubal anastomosis by laparoscopy and laparotomy. J Am Assoc Gynecol Laparosc 2001;8:348–353.
15.
Hawkins J, Dube D, Kaplow M, Tulandi T: Cost analysis of tubal anastomosis by laparoscopy and by laparotomy. J Am Assoc Gynecol Laparosc 2002;9:120–124.
16.
Tan HH, Loh SF: Microsurgical reversal of sterilisation – is this still clinically relevant today? Ann Acad Med Singapore 2010;39:22–26.
17.
Glock JL, Kim AH, Hulka JF, Hunt RB, Trad FS, Brumsted JR: Reproductive outcome after tubal reversal in women 40 years of age or older. Fertil Steril 1996;65:863–865.
18.
Gupta I, Sawhney H, Mahajan U: Macroscopic tuboplasty: reversal of female sterilization. Asia Oceania J Obstet Gynaecol 1990;16:307–314.
19.
Hanafi M: Factors affecting the pregnancy rate after microsurgical reversal of tubal ligation. Fertil Steril 2003;80:434–440.
20.
Stadtmauer L, Sauer V: Reversal of tubal sterilization using laparoscopically placed titanium staples: preliminary experience. Hum Reprod 1997;12:647–649.
21.
Barjot PJ, Marie G, Von Theobald P: Laparoscopic tubal anastomosis and reversal of sterilization. Hum Reprod 1999;14:1222–1225.
22.
Ribeiro S, Tormena R, Giribela C, Izzo C, Santos N, Pinotti J: Laparoscopic tubal anastomosis. Int J Gynecol Obstet 2003;84:142–146.
23.
Farquhar CM: Ectopic pregnancy. Lancet 2005;366:583–591.
24.
Dubuisson J, Chapron C, Nos C, Morice P, Aubriot F, Garnier P: Sterilization reversal: fertility results. Hum Reprod 1995;10:1145–1151.
25.
Kim SH, Shin CJ, Kim JG, Moon SY, Lee JY, Chang YS: Microsurgical reversal of tubal sterilisation: a report on 1,118 cases. Fertil Steril 1997;68:865–870.
26.
Moon H, Joo B, Park S, Kim K, Yoon J, Lee G: Effective method and successful pregnancy in microsurgical tubal reanastomosis: a report on 715 cases. Fertil Steril 2000;74(suppl 1):S201.
27.
Rouzi AA, Mackinnon M, MeComb PF: Predictors of success of reversal of sterilization. Fertil Steril 1995;64:29–36.
28.
Kim JD, Kim KS, Doo JK, Rhyeu CH: A report on 387 cases of microsurgical tubal reversals. Fertil Steril 1997;68:875–880.
29.
Yoon TK, Sung HR, Kang HG, Cha SH, Lee CN, Cha KY: Laparoscopic tubal anastomosis: fertility outcome in 202 cases. Fertil Steril 1999;72:1121–1126.
30.
Gordts S, Campo R, Puttemans P: Clinical factors determining pregnancy outcome after microsurgical tubal reanastomosis. Fertil Steril 2009;92:1198–1202.
31.
Rock JA, Zacur HA, Guzick DS: Tubal anastomosis: pregnancy success following reversal of Falope ring or monopolar cautery sterilization. Int J Gynecol Obstet 1988;26:473.
32.
Van Waart J, Kruger TF, Lombard CJ, Ombelet W: Predictive value of normal sperm morphology in intrauterine insemination: a structured literature review. Hum Reprod Update 2001;7:495–500.
33.
Botha D, Kruger T, Van der Merwe J, Nosarka S: Semen profiles of male partners in females presenting with endometriosis-associated subfertility. Fertil Steril 2009;91:2477–2480.
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