Abstract：
OBJECTIVE: Between 20% and 30% of women who have undergone tubal ligation regret their decision. The alternative to regain fertility for these women is either in vitro fertilization or tubal re-anastomosis. This article presents a systematic review with meta-analysis to assess the current evidence on the efficacy of tubal recanalization surgery in patients who have previously undergone tubal ligation.
METHODS: The search was conducted in the World of Science (WOS) database, The Cochrane Library and ClinicalTrials.gov record using the keywords \"tubal reversal\", \"tubal reanastomosis\" and \"tubal anastomosis\". The review was carried out by two of the authors. Data from 22 studies were evaluated, comprising over 14,113 patients who underwent the studied surgery, following strict inclusion criteria: articles published between January 2012 and June 2022, in English and with a sample size bigger than 10 patients were included. A random-effects meta-analysis was performed.
RESULTS: The overall pregnancy rate after anastomosis was found to be 65.3 % (95 % CI: 61.0-69.6). The percentage of women who had at least one live birth, known as the birth rate, was 42.6 % (95 % CI: 34.9-51.4). Adverse outcomes after surgery were also examined: the observed abortion rate among women who underwent surgery was 9.4 % (95 % CI: 7.0-11.7), and the overall ectopic pregnancy rate was 6.8 % (95 % CI: 4.6-9.0). No differences were found between the outcomes when differentiating surgical approaches: laparotomy, laparoscopy, or robotic-assisted surgery. The patient\'s age was identified as the most significant determining factor for fertility restoration. Finally, when comparing the results of tubal reversal with in vitro fertilization, reversal procedures appear more favorable for patients over 35 years old, while the results are similar for patients under 35 years old, but more data is needed to evaluate this finding.
CONCLUSIONS: Therefore, the available literature review demonstrates that surgical anastomosis following tubal ligation is a reproducible technique with relevant success rates, performed by multiple expert groups worldwide.
METHODS: The search was conducted in the World of Science (WOS) database, The Cochrane Library and ClinicalTrials.gov record using the keywords \"tubal reversal\", \"tubal reanastomosis\" and \"tubal anastomosis\". The review was carried out by two of the authors. Data from 22 studies were evaluated, comprising over 14,113 patients who underwent the studied surgery, following strict inclusion criteria: articles published between January 2012 and June 2022, in English and with a sample size bigger than 10 patients were included. A random-effects meta-analysis was performed.
RESULTS: The overall pregnancy rate after anastomosis was found to be 65.3 % (95 % CI: 61.0-69.6). The percentage of women who had at least one live birth, known as the birth rate, was 42.6 % (95 % CI: 34.9-51.4). Adverse outcomes after surgery were also examined: the observed abortion rate among women who underwent surgery was 9.4 % (95 % CI: 7.0-11.7), and the overall ectopic pregnancy rate was 6.8 % (95 % CI: 4.6-9.0). No differences were found between the outcomes when differentiating surgical approaches: laparotomy, laparoscopy, or robotic-assisted surgery. The patient\'s age was identified as the most significant determining factor for fertility restoration. Finally, when comparing the results of tubal reversal with in vitro fertilization, reversal procedures appear more favorable for patients over 35 years old, while the results are similar for patients under 35 years old, but more data is needed to evaluate this finding.
CONCLUSIONS: Therefore, the available literature review demonstrates that surgical anastomosis following tubal ligation is a reproducible technique with relevant success rates, performed by multiple expert groups worldwide.
摘要：
目的：20%到30%的接受过输卵管结扎术的妇女对她们的决定感到后悔。这些妇女恢复生育能力的替代方法是体外受精或输卵管再吻合。本文通过荟萃分析进行了系统评价，以评估先前接受过输卵管结扎术的患者的输卵管再通手术疗效的当前证据。
方法：搜索是在科学世界（WOS）数据库中进行的，Cochrane图书馆和ClinicalTrials.gov使用关键字“输卵管逆转”记录，“输卵管再吻合”和“输卵管吻合”。审查是由两位作者进行的。对22项研究的数据进行了评估，包括超过14,113名接受研究手术的患者，遵循严格的纳入标准:纳入2012年1月至2022年6月期间发表的英文文章,样本量大于10例患者.进行了随机效应荟萃分析。
结果：发现吻合后的总体妊娠率为65.3％（95％CI：61.0-69.6）。至少有一次活产的妇女的百分比，被称为出生率，为42.6%（95%CI：34.9-51.4）。还检查了手术后的不良结局：接受手术的妇女中观察到的流产率为9.4％（95％CI：7.0-11.7），总体异位妊娠率为6.8％（95％CI：4.6-9.0）。在区分手术入路时，没有发现结果之间的差异：剖腹手术，腹腔镜检查,或机器人辅助手术。患者的年龄被确定为生育能力恢复的最重要决定因素。最后,当比较输卵管逆转与体外受精的结果时，逆转手术似乎对35岁以上的患者更有利，虽然35岁以下的患者的结果相似，但需要更多的数据来评估这一发现。
结论：因此，现有的文献综述表明，输卵管结扎后的外科吻合术是一种具有相关成功率的可重复技术，由全球多个专家组执行。
方法：搜索是在科学世界（WOS）数据库中进行的，Cochrane图书馆和ClinicalTrials.gov使用关键字“输卵管逆转”记录，“输卵管再吻合”和“输卵管吻合”。审查是由两位作者进行的。对22项研究的数据进行了评估，包括超过14,113名接受研究手术的患者，遵循严格的纳入标准:纳入2012年1月至2022年6月期间发表的英文文章,样本量大于10例患者.进行了随机效应荟萃分析。
结果：发现吻合后的总体妊娠率为65.3％（95％CI：61.0-69.6）。至少有一次活产的妇女的百分比，被称为出生率，为42.6%（95%CI：34.9-51.4）。还检查了手术后的不良结局：接受手术的妇女中观察到的流产率为9.4％（95％CI：7.0-11.7），总体异位妊娠率为6.8％（95％CI：4.6-9.0）。在区分手术入路时，没有发现结果之间的差异：剖腹手术，腹腔镜检查,或机器人辅助手术。患者的年龄被确定为生育能力恢复的最重要决定因素。最后,当比较输卵管逆转与体外受精的结果时，逆转手术似乎对35岁以上的患者更有利，虽然35岁以下的患者的结果相似，但需要更多的数据来评估这一发现。
结论：因此，现有的文献综述表明，输卵管结扎后的外科吻合术是一种具有相关成功率的可重复技术，由全球多个专家组执行。
