Tubal resection and anastomosis. II. Isthmic salpingitis

The results of 30 consecutive operations for medial occlusion of the tube due to pathological processes other than sterilization are reported. Resection of the obstructed segments was followed by anastomosis of lateral isthmus or ampulla to the medial isthmus, the interstitial portion of the tube, or the endometrium of the lateral uterine angle, deep in the myometrium. Life table analysis of subsequent pregnancies was carried out in a manner that kept those patients with demonstrated reocclusion after anastomosis in the denominator for the duration of longest follow-up, irrespective of further operations on these patients. The cumulative probability of pregnancy was 55% at 6 months from the time of surgery and 67% at 12 and at 15 months. Empirically, average fecundability, or monthly probability of pregnancy, was 9.3%; of 25 women followed-up and not on contraception, 14 (56.0%) have conceived. Microsurgical tubal anastomosis can effectively replace uterotubal implantation for acquired organic occlusion of the medial tube or lateral uterine angle. Optimum results require precise techniques, wide excision of abnormal endosalpinx, and preoperative treatment of endometritis.