For a reproductive‑aged woman seeking permanent contraception who wants the option for future tubal reversal, is the Kroener method appropriate and how do its failure rate, reversibility success, and complication profile compare to standard tubal ligation or complete bilateral salpingectomy?

Kroener Method (Fimbriectomy) for Permanent Contraception

Direct Answer

The Kroener method (fimbriectomy) is NOT appropriate for women desiring future reversal potential, as it has both higher failure rates (2.4%) compared to standard tubal ligation (<1%) and significantly worse reversibility outcomes than tube-sparing sterilization techniques. 1, 2

---

Failure Rate Profile

The Kroener fimbriectomy technique demonstrates concerning efficacy limitations:

• Failure rate of 2.4% in the largest documented series, substantially higher than the <1% failure rate for standard laparoscopic tubal ligation 1, 3
• Failures occur through two mechanisms: incomplete resection of all fimbriae or formation of tuboperitoneal fistulas (both congenital and acquired) 1
• Critical technical pitfall: Use of absorbable sutures (particularly Vicryl 2/0) creates antimesenterial tubo-peritoneal fistulas; in one series, all 4 failures occurred in the 16 patients where Vicryl was used instead of chromic catgut 4
• The procedure requires complete removal of all fimbrial tissue including the fimbria ovarica with adequate surgical exposure—incomplete removal guarantees failure 1

---

Reversibility Outcomes

While microsurgical reversal is technically possible, outcomes are suboptimal:

• Tubal patency rate of 83% and intrauterine pregnancy rate of only 44% after microsurgical fimbriectomy reversal 2
• Mean time to conception: 6 months in successful cases 2
• Ideal reversal candidates require tubal remnants ≥8 cm, ampullary width ≥1 cm, preserved rugal patterns on hysterosalpingogram, and minimal peritubal adhesions 2
• All fimbriectomy cases were unsuitable for laparoscopic recanalization in one reversal series, whereas laparoscopic tubal ligation cases achieved 85.7% pregnancy rates after reversal 5
• Tube-sparing techniques (Pomeroy, laparoscopic clips/rings) preserve fimbrial function and achieve superior reversal outcomes 6, 5

---

Comparison to Standard Alternatives

Standard Laparoscopic Tubal Ligation

• Failure rate <0.5% in first year, with immediate contraceptive protection 3, 7
• Reversal pregnancy rates of 40-85.7% depending on technique, with laparoscopic methods achieving the highest success 5
• Preserves tubal length and fimbrial architecture, optimizing reversal potential 6, 5
• Final tubal length <5 cm after reversal predicts zero conception rate; tube-sparing methods preserve length 5

Bilateral Salpingectomy

• Not appropriate for women desiring reversal potential—this is permanent and irreversible 3, 8
• Indicated only for cancer risk reduction in BRCA1/2 carriers or as definitive sterilization 3
• Pregnancy after bilateral fimbriectomy (partial salpingectomy) carries 8.5% ectopic risk and 20% spontaneous abortion rate among uterine pregnancies 8

---

Algorithmic Recommendation

For reproductive-aged women seeking permanent contraception WITH reversal potential:

1. First-line: Laparoscopic tubal ligation with clips or rings (NOT fimbriectomy)

   • Minimizes tubal destruction 6
   • Preserves tubal length and fimbrial function 5
   • Achieves <0.5% failure rate 3, 7
   • Optimizes reversal success (up to 85.7% pregnancy rate) 5

2. Counsel extensively about permanency: regret rates 1-26%, highest in women <30 years 7

3. Discuss long-acting reversible contraceptives (IUDs, implants) as alternatives with comparable efficacy but full reversibility 7

4. If reversal is anticipated: Consider delaying sterilization entirely in favor of LARC methods 7

The Kroener fimbriectomy should not be regarded as the method of choice for sterilization unless complete fimbrial removal can be ensured—and even then, it offers no advantage over tube-sparing techniques while compromising reversibility. 1

---

Critical Pitfalls to Avoid

• Do not perform fimbriectomy on women who express any uncertainty about permanency or mention potential future reversal 1, 2
• Avoid absorbable sutures (especially Vicryl) if fimbriectomy is performed—use chromic catgut to prevent fistula formation 4
• Do not confuse with hysteroscopic sterilization, which requires 3-month HSG confirmation before reliability 3
• Younger women (<30 years) have higher failure rates and regret rates with all sterilization methods 7, 5
• Pregnancy risk persists long-term with all tubal sterilization methods, particularly in younger women 3, 7