Deaton, J. L., Gibson, M., Riddick, D. H., & Brumsted, J. R. (1990). Diagnosis and treatment of cornual obstruction using a flexible tip guidewire. Fertility and Sterility, 53(2), 232-236. https://doi.org/10.1016/s0015-0282(16)53272-5
Deaton JL, Gibson M, Riddick DH, Brumsted JR. Diagnosis and treatment of cornual obstruction using a flexible tip guidewire. Fertil Steril. 1990;53(2):232-236. doi:10.1016/s0015-0282(16)53272-5
Deaton, Jeffrey L., et al. "Diagnosis and treatment of cornual obstruction using a flexible tip guidewire." Fertility and Sterility, vol. 53, no. 2, 1990, pp. 232-236.
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Hysteroscopic cannulation succeeded in 13 of 18 blocked tubes
Hysteroscopic cannulation opened 13 of 18 blocked fallopian tubes. This 1990 case series studied 11 women with infertility from a blocked tube near the uterus. Follow-up imaging showed 8 of the 11 rechecked tubes stayed open. Six of the 11 women got pregnant after cannulation and more surgery.
About 5 in 10 women became pregnant after tube cannulation and additional surgery. Source: Deaton JL et al., 1990, PMID 2298308.Study at a glance, case series of 11 women: Hysteroscopic cannulation opened 13 of 18 blocked fallopian tubes. Source: Deaton JL et al., 1990, PMID 2298308.
Key Findings
Hysteroscopic cannulation, which passes a thin wire through the tube opening, succeeded in 13 of the 18 obstructed tubes (72%). Five tubes (28%) could not be cannulated.
Follow-up hysterosalpingogram (HSG), done 2 to 6 months later, showed patency in 8 of the 11 cannulated tubes studied (73%). All three uncannulated tubes that were rechecked remained obstructed.
Six of the 11 women (54%) became pregnant after cannulation and additional surgery. The average time until conception was 6 months.
Three of the six pregnancies were tubal pregnancies in the ampulla, all in women with distal tubal disease. The other three were intrauterine and ongoing at the time of the report.
Two of the 18 tubes were perforated (11%), both within 1 cm of the uterotubal junction, and needed no further therapy. The authors reported no other complications from the procedure.
Interpretation
This case series followed 11 women with a blocked tube near the uterus. The study ran at one university center from July 1987 through October 1988. Each woman had a blockage confirmed two ways: by HSG and by dye testing during laparoscopy. All 11 women also had a full infertility workup, including a postcoital test, an endometrial biopsy, and a semen analysis that was normal. Some women had other surgery at the same time, such as removing scar tissue or fibroids. The authors say a smaller, more flexible guidewire might raise the success rate and lower the risk of perforation. The findings support larger studies of this approach.
RRM Context
A 1987 report cited in this paper examined tissue samples. The report found a true blockage in only 7 of 18 patients (39%) whose HSG showed a blocked tube. Restorative reproductive medicine starts by finding the real cause of infertility. Confirming a blockage is real comes before major reconstructive surgery. IVF bypasses the tubes and leaves unanswered why conception has not happened. The method in this series examines the tube itself and may open it again in some women.
Our editorial summary of this paper, not the article's abstract.
Abstract
Proximal tubal obstruction, either unilateral or bilateral, is a frequent finding on hysterosalpingogram (HSG). Approximately two-thirds of the fallopian tubes resected for proximal tubal obstruction reveal an absence of luminal occlusion. The distinction between true pathologic occlusion and either spasm or plugging is crucial in determining therapy. We combined hysteroscopic cannulation of the proximal fallopian tube with laparoscopy in 11 patients with proximal tubal obstruction diagnosed by HSG and confirmed at laparoscopy. Hysteroscopic cannulation was able to be performed in 72% of the fallopian tubes attempted, and there was a postcannulation patency rate by HSG of 73%. Six of the 11 patients became pregnant after tubal cannulation and adjunctive distal tubal surgery. Hysteroscopic cannulation of the fallopian tube is a safe diagnostic procedure that can be used to identify those patients with true proximal occlusion, and may also serve as a therapeutic procedure in some of these patients.
