Laparoscopic Treatment of Hydrosalpinges for Infertility

Operative laparoscopy can be used for the treatment of distal tubal occlusion associated with sterility. Various laparoscopic techniques have been described using the CO2 laser, bipolar coagulation or sutures. From June 1988 to June 1992, 200 women with complete distal tubal occlusion have undergone laparoscopic salpingoneostomies. Adhesiolysis or fimbrioplasties of at least one tube have been excluded. Past history of the patients revealed a relevant cause for the tubal lesions in 50% of the patients. Chlamydia serology was positive (1/64 or more) in 66% of the patients. Various degrees of adhesiolysis were required in 97% of the cases. Complementary procedures were performed in 13% of the patients. The degree of tubal damage was prospectively assessed according to the classification of Mage and Bruhat. All patients had at least one year of follow-up. Preliminary results indicate that laparoscopic salpingoneostomy provides conceptions earlier with rates similar to those obtained with the microsurgical approach. The success correlated with the amount of tubal damage.