Laparoscopic surgery for distal tubal occlusions Lessons learned from a historical series of 434 cases

Capsule:
Fertility after laparoscopic neosalpingostomy is largely dependent on the tubal status and should only be proposed for patients with tubal stage 1 or 2.

Authors:
Alain Audebert, M.D., Jean Luc Pouly, M.D., Ph.D., Béatrice Bonifacie, C.R.A., Chadi Yazbeck, M.D., Ph.D.

Volume 102, Issue 4, Pages 1203-1208

Abstract:

Objective:
To evaluate the success rate of laparoscopic neosalpingostomy and the factors affecting the results in terms of intrauterine pregnancy (IUP), delivery (DEL), and ectopic pregnancy (EP).

Design:
Retrospective analysis of prospectively recorded data.

Setting:
Private practice.

Patient(s):
A total of 434 consecutive infertile patients from 21 to 42 years old with a follow-up of more than 10 years.

Intervention(s):
Laparoscopic neosalpingostomy.

Main Outcome Measure(s):
Intrauterine pregnancy, delivery, and EP rates obtained without requiring IVF. Statistical analysis includes univariate and multivariate analysis and crude and actuarial success rates.

Result(s):
Just over one-quarter (28.8%) of the patients presented an IUP, 24.4% delivered, and 9% presented with an EP. The 5-year actuarial rate of delivery was 37%. This rate was largely dependent on the tubal stage (stage 1: 53.1%; stage 2: 43.1%; stage 3: 24.0%; stage 4: 23.1%). Forty-three percent of the expected IUPs started in the first year, and 75% started in the first two years. Multivariate analysis found some poor-prognosis patterns for tubal stage 3 (odds ratio [OR] 0.24), tubal stage 4 (OR 0.28), repeated neosalpingostomy (OR 0.168), previous EP (OR 0.202), severe adhesion stage (OR 0.211), and positive chlamydial serology (OR 0.515). Eversion with sutures provides nonsignificantly better results (OR 1.63) compared with eversion with coagulation.

Conclusion(s):
Neosalpingostomy must not be proposed in selected cases according to the tubal stage, adhesion stage, and chlamydial serology. When neosalpingostomy is performed, fimbrial eversion with sutures provides slightly better results.

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