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Hydrosalpinx: Functional Surgery or Salpingectomy

Microsurgical Tubocornual Anastomosis scopy. The absence of radiolucent bands corresponded to
abnormal mucosa at salpingoscopy in four of six cases.
Microsurgical tubocornual anastomosis is a procedure The cobblestone pattern was found only in hydrosalpinges
where the patent portion of the distal tube is joined to the
uterine cavity under magnification. This procedure has been and never in patent tubes. Six normal patent tubes at HSG
5
showed intraluminal adhesions at salpingoscopy.
regarded as the standard treatment for proximal tubal
35
occlusion. However, some spontaneous intrauterine Salpingectomy
pregnancies have been seen in women with proximal tubal
31
obstruction. This type of surgery is more effective for Strandell et al performed a randomized control trial that
women with mild hydrosalpinges and should be considered analyzed the effect of salpingectomy on birth rates and IVF
especially in centers where appropriate expertise is available. 35 cycles. A total of 186 women underwent 452 IVF cycles.
The aim of the review was to highlight the use of Among these, 77 women had no surgical intervention and
appropriate tubal function tests to help in making a choice 24 had salpingectomy after 1 or 2 failed IVF cycles.
between either salpingectomy or functional tubal surgery Salpingectomy group had a significantly increased birth rate
as treatment for hydrosalpinges. (HR 2.1, 95% CI 1.6-3.6, P = 0.014) and higher implantation
A literature search was performed using the search rates (27.2% versus 20.2%, P = 0.03.31).
engine Google, HighWire press, PubMed and SpringerLink. A systematic review that included six studies, comparing
Selected papers were taken for further references. All pregnancy outcomes after laparoscopic surgery with that
articles, including randomized controlled trial (RCT) were of open or conventional microsurgical technique was done
15
included for the review. by Ahmad et al. In this review, there was no significant
difference observed in the intrauterine pregnancy rate
RESULTS between the two groups, combined OR (odds ratio) 1.32
(95% confidence interval [CI], 0.58-3.02). For patients with
Salpingoscopy
mild tubal disease, there was no significant difference in
2
Puttemans et al utilized translaparoscopic salpingoscopy the intrauterine pregnancy rate between treatment and control
to evaluate the ampullary segment of the fallopian tube in group, OR 1.06 (95% CI, 0.42-2.70). For patients with
patients suffering from infertility. Their study compared severe tubal disease, there was a significantly increased
this technique with HSG in a series of 32 patients with intrauterine pregnancy rate in the laparotomy group, OR
hydrosalpinges and demonstrated the superiority of 0.34 (95% CI, 0.14-0.86). 15
29
salpingoscopy in the evaluation of tubal mucosa. This Sagoskin et al reported on their retrospective
diagnostic approach allows a more accurate selection of observational study of 25 infertility patients with known
patients for microsurgical repair. 7 unilateral hydrosalpinges and a patent contralateral fallopian
5
Valentini et al performed a prospective study to identify tube. Eighteen of these women subsequently had
radiographic signs of mucosal damage by comparing HSG spontaneous pregnancies after laparoscopic salpingectomy
with salpingoscopy. Forty-one candidates for laparoscopy without IVF treatment. Pregnancies occurred in an average
underwent HSG and preoperative salpingoscopy; at both, of 5.6 months with a range of 1 to 21 months. There were
tubal patency was noted. Radiographic criteria for mucosal no ectopic pregnancies in the study population. 29
28
abnormality were rounded filling defects (i.e. the cobblestone Another study performed by Kontoravdis et al that
pattern) and the absence of longitudinal radiolucent bands evaluated and compared the clinical impact salpingectomy,
in the ampullary tract. At salpingoscopy, tubal mucosa was when performed before IVF in patients with hydrosalpinges,
categorized by means of inspection into five classes of fold found that patients who underwent proximal tubal occlusion
pattern: Classes I and II, normal; classes III-V, abnormal. before IVF demonstrated significantly increased implantation,
Seventy-four tubes were evaluated. At HSG, 31 tubes were clinical pregnancy, and ongoing pregnancy rates compared
distally non-patent. Of these, 26 showed a distal obstruction to those with no surgical intervention and demonstrated
at salpingoscopy. None of the patent tubes at HSG showed implantation, clinical pregnancy, and ongoing pregnancy
obstruction at salpingoscopy. The agreement between HSG rates comparable to those who underwent salpingectomy. 28
and salpingoscopy in detecting abnormal mucosal pattern A Cochrane systematic review was performed by
27
was 89.2% (κ, 0.73; P < 0.001). The cobblestone pattern Johnson et al to highlight evidence that laparoscopic
always corresponded to intraluminal adhesions at salpingo- salpingectomy for women with hydrosalpinges enhances

World Journal of Laparoscopic Surgery, September-December 2010;3(3):145-150 147