Live births followed hydrosalpinx microsurgery in 27% of 41 women
In a 1978 series of 41 women followed over a year, live births followed tube microsurgery in 27% of women. The women had hydrosalpinx (a tube blocked at its far end and swollen with fluid), and one Vancouver surgeon operated on all of them. Over 90% of patients had open tubes afterward.
Key Findings
Among the 41 women analyzed, 12 (29%) had one or more pregnancies in the uterus, and 11 (26.8%) had live births.
Five women (12%) had tubal pregnancies, all in the first year after surgery. One of the five later had a live birth.
Five of the 12 uterine pregnancies (42%) occurred in the first year. The paper puts the share after the first year at almost 60%.
Over 90% of patients had open tubes after surgery. Of the 25 women not pregnant, 3 had blocked tubes again and 2 had later pelvic inflammatory disease.
Fifty women had the operation: 32 on both tubes and 18 on one. In over 60% of cases, adhesions fixed the tube and ovary to the pelvis.
Interpretation
The report is a single-surgeon case series with no comparison group. It describes outcomes and cannot show that microsurgery caused them. Nine of the 50 women were left out of the analysis, and the author says selection for surgery was not rigorous. The author notes the uterine pregnancy rate may improve with longer follow-up, since almost 60% of the women who became pregnant did so after the first year. Tubal damage, adhesions and technique differ between series, which limits comparison. The author suggests the 12% tubal pregnancy rate may reflect more severe tubal damage in his patients. Three conventional-technique series he cites had lower rates at comparable uterine pregnancy rates.
RRM Context
Restorative reproductive medicine looks for the cause of infertility and repairs it where possible. The paper's workup covered the couple, with a semen analysis and temperature charting before surgery. Tubal surgery repairs the damaged tube and aims to restore its function. IVF goes around a damaged tube and leaves the damage in place.
Our editorial summary of this paper, not the article's abstract.
Abstract
Salpingostomy for hydrosalpinx was carried out using a microsurgical technique. The postoperative patency rate was over 90%. Among the 41 patients followed for more than 1 year, 29% have had one or more intrauterine pregnancies and 27% have had live births. The ectopic gestation rate was 12%. All of the tubal gestations occurred in the 1st postoperative year whereas 60% of the intrauterine pregnancies occurred after the 1st year, suggesting a degree of restoration in the mucosa and the musculature of the oviduct with the re-establishment of patency and the passage of time.
Obrzut B et al., 2022·Journal of clinical medicine·Free full text on PubMed Central
Tubal diseases account for 25-40% of female factor infertility. Mainly, they involve the distal part of the fallopian tube, and hydrosalpinx is the most severe manifestation. Usually, the management decision is made between reconstructive surgery and ART, depending on the severity of the tubal damage, patient age, ovarian reserve, and seminogram, as well as financial, religious, ethical, and psychological factors. Estimated live-birth rates after corrective surgery range from 9% to 69%. The success rate of IVF is about 30% live-birth rate per cycle initiated in women across all ages with tubal factor infertility. Surgery offers a long-term cure and patients may attempt conception many times but are burdened with perioperative adverse events. IVF bypasses potential complications of operative treatment; however, this has its own unique risks. The effectiveness of reconstructive surgery versus ART has not been adequately evaluated. The success of fertility management depends on a thorough interpretation of existing data and careful patient selection. The presented review provides updates on the most recent progress in this area.
More than 70 million couples suffer from infertility worldwide. The aim of this study was to evaluate the fertility outcomes after laparoscopic fimbrioplasty and neosalpingostomy in female infertility. Laparoscopic distal tuboplasty was carried out for 402 cases at the Gynecological Endoscopic Surgery and Human Reproductive Teaching Hospital in Yaoundé-Cameroon in Central Africa from December 2002 to December 2007. Laparoscopic fimbrioplasty and neosalpingostomy were done using bipolar electrocoagulation and conventional endoscopic instruments. Log-rank test was used to compare cumulative rate curves of intrauterine pregnancy with respect to the tubal stages. P<0.05 was considered statistically significant. The mean age of the patients was 31.6±5.45 years. Secondary infertility was the most frequent type of infertility (70.14%). The laparoscopic tubal surgery done consisted of fimbrioplasty in 185(46%) cases and neosalpingostomy in 217 (54%) cases. Of 260 women followed up after tuboplasty, there were overall 74 (28.48%) pregnancies; 68(26.1%) intrauterine pregnancies and 6(2.3%) ectopic pregnancies. Pregnancy rates were significantly associated to the tubal stage (63% in stage 1, 15% in stage 3 and 00% in stage 4; p<0.001) and the adnexal adhesion scores (73.91% in the absence of adnexal adhesions and 8.8% in the case of a severe adnexal adhesion score). Of the 68 intrauterine pregnancies, there were 60(88%) live births and 8(12%) spontaneous abortions. It is believed that laparoscopic fimbrioplasty and neosalpingostomy should be the preferred choice when faced with tubal distal occlusion in a context of female infertility. This implies that training in endoscopic surgery should be regarded as an important issue in developing countries.
Kasia JM et al., 1997·European journal of obstetrics, gynecology, and reproductive biology
OBJECTIVE(S): To study the fertility results after laparoscopic distal tuboplasty and compare them with the data in the literature. 194 laparoscopic distal tuboplasties were carried out from May 1992 to May 1994 in the Yaounde General Hospital (Cameroon). The results were analysed according to the age of the patients, the type and duration of infertility, past history of abortion, laparotomy and Chlamydia trachomatis infection, the tube and adhesion scores, surgical procedures and achievement of pregnancy. The fertility rates were calculated according to Cramer's method [11]. The cumulative pregnancy rate curves were drawn up from the life table [12] and compared using the Log-Rank test. 53 patients obtained pregnancy (27.3%) of which 45 were inter-uterine (23.2%) and 8 ectopic (4.1%). Of the 45 intra-uterine pregnancies (IUP), 36 were obtained after fimbrioplasty (33.3%) and 9 after neosalpingostomy (10.5%). The monthly fertility rate at one year was 1.4%. The rate of IUP for tube stages I and II is significantly higher than that for stages III and IV (p<0.001). However the rate of ectopic pregnancies (EP) is proportional to damage to the tubes. Infection with Chlamydia trachomatis, and residual inflammation could have an effect on the achievement of pregnancy. CONCLUSION(S): Our results are similar to those found in the literature. The tube stage thus remains the decisive factor in terms of fertility (Cox: p<0.001). Operative laparoscopy is the best alternative in our countries compared with laparotomy for distal tubal pathology.
To determine pregnancy rates (PR) after fimbrioplasty and salpingostomy in nonocclusive distal tubal disease. To evaluate the relative impact of various factors using contemporary statistical analysis. Prospective cohort. Tertiary institutional infertility clinic. PATIENTS(S): Infertility patients. INTERVENTION(S): Fimbrioplasty and salpingostomy. MAIN OUTCOME MEASURE(S): Cumulative PR, monthly fecundity rates, monthly probability of pregnancy, crude PR, and cure rates. RESULTS(S): Thirty-five percent of patients conceived with a cure rate of 72.2%, monthly probability of pregnancy of 3.9%, and monthly fecundity rate of 3.9%. Cumulative PRs were 22%, 35%, and 58% at 6, 12, and 24 months, respectively. Pairwise comparisons (unilateral, bilateral, or either) failed to detect any statistical difference between the salpingostomy and fimbrioplasty groups. Salpingostomy patients initially may have a higher tendency to become pregnant but appear to lose that advantage after the first few months. When patients with tubo-ovarian adhesions are excluded from the analysis, patients who underwent a bilateral salpingostomy as their sole procedure had better outcome compared with those who only underwent bilateral fimbrioplasty. There was no significant association between pregnancy outcome and the presence of endometriosis, other infertility factors, or tubo-ovarian adhesions. The staging of adnexal adhesions and endometriosis did not predict pregnancy outcome. CONCLUSION(S): Laparoscopic fimbrioplasty and salpingostomy are clinically efficacious for the treatment of nonocclusive distal tubal disease. After accounting for statistical interactions of various factors among them, no particular association with pregnancy outcome could be identified. This illustrates the need for a revision of the classification of patients with distal tubal disease.
Reproductive Surgery › Tubal Surgery › Tubal Cannulation · Infertility › Tubal Factor › Distal Tubal Disease
Victor Gomel
V Gomel
PMID 148372 148372 DOI 10.1016/s0015-0282(16)43210-3 10.1016/s0015-0282(16)43210-3 Gomel et al. 1978, Gomel 1978
Cite this article
Gomel, V. (1978). Salpingostomy by microsurgery. Fertility and sterility, 29(4), 380-387. https://doi.org/10.1016/s0015-0282(16)43210-3
Gomel V. Salpingostomy by microsurgery. Fertil Steril. 1978;29(4):380-387. doi:10.1016/s0015-0282(16)43210-3
Gomel, Victor. "Salpingostomy by microsurgery." Fertility and sterility, vol. 29, no. 4, 1978, pp. 380-387.
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