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Laparoscopic distal tuboplasty: report of 87 cases and a 4-year experience
1Department of Obstetrics, Gynecology, and Reproductive Medicine, Polyclinique de l'Hôtel Dieu, Centre Hospitalier Régional et Universitaire, Clermont-Ferrand, France.
Objective:
To evaluate fertility results after laparoscopic distal tuboplasty and to compare these results with those obtained previously with microsurgery.
Design:
Retrospective, nonrandomized.
Setting:
Department of Obstetrics and Gynecology at the University Hospital of Clermont-Ferrand, France.
Patients:
All the distal tuboplasties performed between October 1985 and June 1989 were included. Adnexal damage was assessed using tubal and adhesions scoring systems described previously. Tuboplasty was carried out bilaterally except when one tube was absent or severely damaged (tubal stage III or IV and/or with severe adhesions). Patients with bilateral severe adnexal damages were treated only if they refused to undergo in vitro fertilization. Laparoscopic tuboplasty was performed either with the CO2 laser or with conventional instruments.
Main Outcome Measure:
Fertility after laparoscopic treatment was evaluated using simple and cumulative pregnancy rates (PRs) according to the adnexal damage and compared with the microsurgical results using PRs according to the adnexal damage.
Results:
The overall intrauterine and extrauterine PRs were 33.3% and 6.9%, respectively. Twenty-six of the 29 intrauterine pregnancies were obtained within the 1st postoperative year. According to tubal and adhesion stages, the results of laparoscopic distal tuboplasty are similar to those obtained using microsurgery.
Conclusion:
We conclude that laparoscopic distal tuboplasty, when performed by experienced surgical laparoscopists, represents an effective alternative to microsurgery.