Pregnancy outcome in neosalpingostomy by the cuff vs Bruhat technique using the carbon dioxide laser

Distal tubal occlusion is one of the most challenging conditions that the reproductive surgeon faces in the management of tubal disease. This study was designed to compare the pregnancy rates between two well-known techniques for tuboplasty using the carbon dioxide laser from March 1982 to October 1988. Alternate infertility patients with distal tubal occlusion were assigned to either a cuff or Bruhat technique. Only patients with bilateral hydrosalpinges and no other infertility factors qualified for this study. Nineteen patients had a cuff neosalpingostomy, and 15 patients had a Bruhat neosalpingostomy. Two patients who were assigned to the Bruhat technique had to be changed to the cuff technique because of technical problems. The mean age and length of infertility were similar in both groups. Six patients in the cuff group (31.6%) and 5 (33.3%) in the Bruhat group conceived. One ectopic pregnancy occurred in each group. This study shows that both techniques produce similar pregnancy rates. The Bruhat technique is considerably faster but cannot be applied adequately when the fallopian tubes have thick walls.