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Tubal patency and conception rates with three methods of laparoscopic terminal neosalpingostomy
1Department of Obstetrics and Gynecology, Chonnam University Medical School, 8 Hakdong, Tongku, Kwangju 501-190, Korea.
Study Objective:
To determine the best method of laparoscopic neosalpingostomy for terminal tubal obstruction with respect to postoperative tubal patency and pregnancy.
Design:
Three-year follow-up study.
Setting:
University hospital.
Patients:
Eighty-two women.
Interventions:
Clubbed fimbriae were incised with scissors and sutured after eversion in 26 patients (type 1 procedure), and incised with needle diathermy and everted by endocoagulator without suturing in 27 (type 2). In 29 women the original fimbrial shape was restored by traction with grasping forceps after making a small hole with needle diathermy, and the fimbriae were sutured after eversion (type 3).
Measurement And Main Results:
Tubal patency rates on hysterosalpingogram 2 months after the three operations were 13 (50%) of 26 patients for type 1, 23 (85.1%) of 27 patients for type 2, and 28 (96.2%) of 29 patients for type 3. Tubal patency for types 2 and 3 was significantly higher than for type 1 (p <0.01). Conception rates within 3 years for the procedures were 5 (19.2%) of 26 women for type 1, 10 (37.2%) of 27 for type 2, and 14 (48.2%) of 29 for type 3. The conception rate for type 3 was significantly higher than that for type 1 (p <0.05). Especially when the operation was performed in women with favorable prognostic conditions, the conception rate was 9 (64.3%) of 14 women for type 3 operation.
Conclusions:
The type 3 procedure was the most effective method of laparoscopic neosalpingostomy for terminal tubal obstruction, especially when performed in patients with favorable prognostic factors.