To understand this, you need to know what tubal ligation refers to.  Of course, the tubal part is easy.  That means your fallopian tubes.  The ligation part means to bind up or surgically tie with ligatures (or ties).  While there are several methods such as coagulation, Adiana, Essure, clips, and rings which create tubal blockage, there are only three we will talk about here which involve ligatures.  The good news is that tubal reversal success with each ligature method is very good.

The first tubal ligation procedure which involves ligatures is the granddaddy of all methods of tying your tubes.  It was created by Dr. Pomeroy around a century ago.  It's been around a long time and is where the colloquial of "tying tubes" comes from.  It is still the most common method today.

In the Pomeroy tubal ligation procedure, working on one fallopian tube at a time, the doctor will double it up to make a loop.  At the bottom of the loop, he will apply an absorbable ligature in essence tying the tube.  Not precise, but think of it as tying a string around the bottom.

Just above the ligature, he will cut or resects out the doubled up section leaving two cut ends.  As the ligature is absorbed, the ends will be covered over by the peritoneum essentially being scarred over so no sperm can travel up the tube nor egg from the ovary travel down the tube.  In this manner, you are infertile.  Tubal reversal success for this type of procedure is more than 60% and depends upon how much tube was removed.

The next two types of tubal ligation involving ligatures are variations.  In the Parkland tubal ligation procedure, the fallopian tube is not doubled up.  Instead two non-absorbable ligatures are applied along the mid segment a little distance from each other.  The surgeon then resects, or cuts, the tube between the two ligatures and removes it.  Again, your success rate will depend upon how much was removed and your age as well.

The Irving tubal ligation procedure is a variation on the Parkland.  It is done the same way but finished slightly differently in that the segment that remains attached to the uterus is then sutured to and behind the uterus.  The other segment's cut end is buried in the connective tissue underlying the fallopian tubes.

Do You Really Untie Tubes in Tubal Reversal Surgery?

The oldest type of tubal ligation was done by the ligature and resection method.  This is probably where the colloquial "tying tubes" came from as a ligature is tied around the fallopian tubes in such a way as to make a loop in each tube.  The resection part comes when the looped part of the tubes is cut away and removed.

However, the ligature is absorbed by the body so there is nothing to untie when it comes to tubal reversal surgery.  The cut ends of each tube become covered with some of the tissue within the abdomen effectively sealing off each part.  Just think of the ends as being scarred over.  This creates an effective tubal blockage in the vast majority of cases.

During tubal reversal surgery, your surgeon will have to remove the closed over ends creating two open sections in each tube.  Then he must put these ends together in such a way that they will heal back together once more creating a pathway for the egg to move down to the uterus.  A renowned tubal reversal doctor does this by suturing together two of the three layers of the fallopian tubes.

He doesn't suture together the thin inner layer which is covered by cilia.  It is these cilia that transport the egg down to the uterus with their waving motion.  He doesn't do the suturing here in order to keep additional scarring of the tubes down to a minimum.  He also feels from his vast experience of over 7000 tubal reversal surgeries that the two outer layers being sutured together provides the strength to hold the tube sections in place until healing is accomplished.

Not all types of female sterilization include ligatures or resecting.  Additional methods include coagulation where "burns" are made in one, two or even three places along the tubes, fimbriectomy wherein the fimbrial end is removed, clips or rings applied around the tubes, or even other mechanical devices like the Adiana or Essure which are actually inserted within the tubes to create tubal blockage.  So you can see how "untie tubes" can be a real misnomer.

The bottom line in tubal reversal surgery though is that your surgeon will have to remove whatever is causing the tubal blockage plus whatever parts of the fallopian tubes have been damaged.  For instance, in coagulation he has to remove all the burned part(s) and then reattach to each other the good sections left.

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