Laparoscopy in the Treatment of Tubal Infertility

Since 1992 we have performed 371 bilateral salpingostomies in infertile women (age 20-32 yrs, infertility duration 2-9 yrs) with blockage in the ampullas. Salpingostomy was performed after retrieving the tube from the commisure and filling it with methylene blue. The ampullary part of the tube was grasped at 1 to 2 cm to place the stoma, the wall was coagulated, and the site of greatest thinness of the star scar was dissected by microscissors. The fimbriae were identified and washed with physiologic heparinized solution. The distal tubal serosa was lightly coagulated with point endocoagulation along the perimeter. The abdomen was irrigated with physiologic heparinized solution, and a small amount of solution was left for hydroflotation. Second-look laparoscopy with chromopertubation in 1.5 months revealed 234 patent tubes (63.1%), 66 commissures (17.8%), 23 cases of one patent tube and the other with a hydrosalpinx (6.2%), and 48 recurrent hydrosalpinges (12.9%). One hundred three women conceived within 6 months, with 86 (23.2%) uterine and 17 (4.6%) tubal pregnancies. Laparoscopic treatment of hydrosalpinges restored tubal patency with minimal risk of complications.