title: Sutureless re-anastomosis by laparoscopy versus microsurgical re-anastomosis by laparotomy for sterilization reversal: a matched cohort study.
abstract: BACKGROUND
  Sutureless re-anastomosis per laparoscopy is an alternative for microsurgical re-anastomosis by laparotomy in the treatment of sterilized women with renewed child wish. Our aim was to compare pregnancy rates after both surgical techniques.
  
  
  METHODS
  We performed a retrospective cohort study in which consecutive women who underwent sutureless re-anastomosis per laparoscopy were compared to women who underwent microsurgical re-anastomosis by laparotomy. Both procedures were performed in neighbouring hospitals in Northern-Brabant, The Netherlands, and women were matched for age. The primary outcome was time to ongoing pregnancy.
  
  
  RESULTS
  Overall, we included 41 women who had sutureless re-anastomosis by laparoscopy, and 41 age-matched women who underwent microsurgical re-anastomosis by laparotomy. The number of women who conceived was 20 (15 ongoing pregnancies) in the sutureless laparoscopic group versus 26 (24 ongoing pregnancies) in the laparotomic group, a difference due to a longer follow-up period in the laparotomic group. Time to ongoing pregnancy was comparable in both groups (P=0.46), with 3 year cumulative ongoing pregnancy rates of 45 and 52% respectively. After adjustment for other prognostic factors, the fecundity rate ratio was 0.97 (95% CI 0.26-3.6), indicating a similar performance of the two techniques.
  
  
  CONCLUSIONS
  The simplified stitchless laparoscopic procedure for reversal of tubal sterilization with the use of a tubal splint, clip fixation of the muscularis and fibrin glue resulted in a promising pregnancy rate, which was similar to the pregnancy rate obtained with the microsurgical re-anastomosis per laparotomy.
authors.affiliation: Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, The Netherlands. m.wiegerink@mmc.nl
authors.forename: Maarten A H M
authors.initials: MA
authors.lastname: Wiegerinck
authors.forename: Maryse
authors.initials: M
authors.lastname: Roukema
authors.forename: Piet H
authors.initials: PH
authors.lastname: van Kessel
authors.forename: Ben W J
authors.initials: BW
authors.lastname: Mol
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007813:Laparotomy; D008866:Microsurgery / Q000379:methods*; D011247:Pregnancy; D018873:Pregnancy Rate; D012189:Retrospective Studies; D013243:Sterilization Reversal / Q000379:methods*; D013537:Sutures; D016896:Treatment Outcome