Page 27 - World's Most Popular Laparoscopic Journal

Nomonde D Gumata

the success of IVF. Three randomized controlled trials were 27% with diathermy; OR = 1.30; 95% CI 0.77 to 2.19). 15
included in the review. The results showed that the odds of A review of 10 case series in women who underwent
pregnancy [odds ratio (OR) = 1.75, 95% confidence interval neosalpingostomy for distal tubal occlusion (n = 1128)
(CI) 1.07-2.86] and of ongoing pregnancy and live birth reported a cumulative ectopic pregnancy rate per pregnancy
(OR = 2.13, 95% CI 1.24-3.65) were increased with of 23%. 6
laparoscopic salpingectomy for hydrosalpinges prior to IVF.
There were no significant differences in the odds of embryo Microsurgical Tubocornual Anastomosis
implantation (OR = 1.34, 95% CI 0.87-2.05), ectopic A review of nine other case series studies reported that
pregnancy (OR = 0.42, 95% CI 0.08-2.14), miscarriage about 50% of women with proximal tubal blockage who
(OR = 0.49, 95% CI 0.16-1.52) or treatment complications had microsurgical tubocornual anastomosis achieved a term
(OR = 5.80, 95% CI 0.35-96.79). 27 pregnancy. Case series and cohort studies have
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The latest Cochrane review, performed by Johnson demonstrated high pregnancy rates in women who
25
et al on surgical treatment for tubal disease in women due underwent this type of surgery. A case series study
35
to in vitro fertilization is also available. In this review, five reported live birth rates of 27%, 47% and 53% within one,
randomized controlled trials involving 646 women were two and 3.5 years of surgery respectively. 41
included. Four studies assessed salpingectomy versus no
treatment. The odds of ongoing pregnancy (Peto OR 2.14, DISCUSSION
95% CI 1.23 to 3.73) and of clinical pregnancy (Peto OR
2.31, 95%CI 1.48 to 3.62) however, were increased with Data available in the literature strongly suggest that surgical
laparoscopic salpingectomy for hydrosalpinges prior to treatment of hydrosalpinges improves the pregnancy rate
11
IVF. 25 in IVF. However, surgery is not without risks and the
need to avoid the practice of indiscriminant salpingectomy
Fimbrioplasty in all women with hydrosalpinges who are undergoing IVF,
makes the ability to identify women at risk for suboptimal
34
Donnez and Casanas Roux studied the prognostic factors IVF success increasingly important. Hence, preoperative
11
of fimbrial microsurgery. They operated upon 257 women patient selection is an essential step in surgical treatment
and found that after fimbrioplasty for occlusion of degree I for hydrosalpinx. 11 Tubal patency test utilizing tubal
34
the term pregnancy rate was > 50%. On systematic review endoscopy plays an important role in selection of hydro-
of eight RCTs and 14 observational studies, found no salpinges for different surgical treatments. Valentini et
4-7
difference in pregnancy rates between the different al in their study showed intraluminal disease in patent tubes
5
techniques used such as CO laser adhesiolysis versus might not always be excluded on normal HSG. Their study
2
5
diathermy adhesiolysis (53% with laser versus 52% with together with several other studies have shown that tubal
15
diathermy; OR = 1.04; 95% CI 0.65 to 1.67). The review patency tests are not appropriate for assessing tubal
of 14 observational studies did not detect a difference function. 4-8 Hence, this emphasizes the importance of
between laparoscopic adhesiolysis and microsurgical utilization of tubal function tests. However, tubal function
39
38
adhesiolysis in improving outcome. Audebert et al in a tests are still unpopular and not performed routinely in many
prospective study reported 51% clinical pregnancy rate and countries.
23% ectopic pregnancy rate in 35 patients with severe The main advantages of laparoscopic surgery over micro-
fimbrial occlusion treated by laparoscopic fimbrioplasty.
surgery in the treatment of hydrosalpinx are that the
laparotomy incision is avoided leading to less postoperative
Salpingostomy or Neosalpingostomy
discomfort and pain, shorter hospitalization, and quicker
34
Donnez and Casanas Roux operated upon 257 women resumption of normal activities. 11,36,37 However, the
and found that after salpingostomy for degree II, III and IV reproductive outcomes after laparoscopic surgery are similar
fimbrial tube occlusion, the term pregnancy rate was > 50%, to that of open microsurgery. 11
25% and 22%, respectively. On systematic review of eight Several studies have shown that laparoscopic
RCTs and 14 observational studies evaluating various salpingectomy improves IVF outcomes. 2-4,31 However, this
surgical techniques for treating tubal infertility, found no procedure is not ideal for every woman with hydrosalpinx. 11
difference in pregnancy rates between laser salpingostomy Laparoscopic salpingectomy should be performed only when
versus diathermy salpingostomy (35% with laser versus hydrosalpinges are beyond repair or in cases of IVF failure. 8

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