Page 58 - World Journal of Laparoscopic Surgery

CLINICAL TECHNIQUE
Is Laparoscopy Valuable for Detection of Distal Fallopian

Tubal Peristalsis?

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Atef Darwish , Dina Darwish 2
Received on: 14 December 2022; Accepted on: 20 February 2023; Published on: 05 September 2023

AbstrAct
Objectives: To evaluate the usefulness of employing laparoscopy to observe distal fallopian tube (FT) peristalsis and to compare its efficacy to
the hysteroscopic viewing of proximal FT peristalsis in normal and hydrosalpingeal FT.
Design: A prospective comparative cohort study.
Patients and methods: One hundred and fifteen infertile women undergoing concomitant diagnostic or operative laparoscopy and hysteroscopy
were divided into two groups. Group A comprised 59 cases with apparently normal FTs while group B comprised 56 cases with hydrosalpingies.
Setting: Endoscopy unit of a tertiary university hospital.
Methods: Fallopian tube status was assessed during diagnostic or therapeutic laparoscopy, including whether morphologically normal and
patent or not. Whenever possible, monitoring of the distal ends of both FTs was performed to detect any potential peristalsis. The proximal
portions of each FT were then subjected to hysteroscopy to assess proximal tubal peristalsis. The effectiveness of laparoscopy in assessing
distal FT peristalsis and comparing its findings to the hysteroscopic assessment of proximal FT peristalsis in normal and pathologic FT were
the primary outcomes.
Results: Laparoscopic detection of distal tubal peristalsis either in normal or hydrosalpingeal FT was low [5 (4.2%) and 5 (4.4%)] in both groups,
respectively. After the exclusion of cases with unilateral patent FT from group B, the percentage dropped to 3.2% (only three FT). Hysteroscopic
detection of proximal tubal peristalsis was significantly higher in group A [80 (67.8%) vs 40 (35.7%)] in total group B.
Conclusions: Laparoscopic evaluation of distal FT peristalsis, whether for healthy or pathologic FT, is of limited utility and is not advised. Its
effectiveness is significantly lower than the hysteroscopic evaluation of proximal FT peristalsis.
Keywords: Anatomy, Hysteroscopy, Hydrosalpinx, Laparoscopy, Peristalsis, Physiology.
World Journal of Laparoscopic Surgery (2023): 10.5005/jp-journals-10033-1563

IntroductIon
Peristalsis, or the contractility of the fallopian tube (FT), is a 1,2 Department of Obstetrics and Gynecology, Assiut University, Assiut,
recognized physiological phenomenon. For the proximal, middle, Egypt
and distal sections, respectively, it may be continuous tonic Corresponding Author: Atef Darwish, Department of Obstetrics
contractions, brief periodic contractions, or a series of oscillating and Gynecology, Assiut University, Assiut, Egypt, Phone:
movements. It provides proper mixing of tubal secretions necessary +20 0201001572723, e-mail: atef_darwish@yahoo.com
for the gametes and embryo, acts as a functional gate at the utero- How to cite this article: Darwish A, Darwish D. Is Laparoscopy Valuable
tubal junction and ampullary–isthmic junction, and aids in the for Detection of Distal Fallopian Tubal Peristalsis? World J Lap Surg
1,2
oocyte pick-up process in the three parts, respectively. It has been 2023;16(1):57–60.
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proven for a very long period in several animals, experimental or Source of support: Nil
in vitro human research. 4–6 Right now, it is accepted that FT patency Conflict of interest: None
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testing is considered a tubal function test that includes peristalsis.
Numerous cases of infertility have been satisfactorily explained
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by gynecologic endoscopy in contemporary clinical practice.
Endoscopic visualization of proximal FT peristalsis is achievable and was registered at ClinicalTrials.gov (ID: NCT03953586). It
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utilizing office hysteroscopy. The purpose of this study was to included infertile women in the reproductive age group subjected
evaluate the utility of laparoscopy for distal FT peristalsis visibility to combined laparoscopy and hysteroscopy to be done under
in normal and hydrosalpingeal FT, and to compare outcomes to general anesthesia due to different indications as previously
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hysteroscopic detection of proximal FT peristalsis. recommended. After proper counseling, informed written
consent was taken from every case. Detailed clinical, sonographic,
and radiologic assessments of all cases were similar to a previous
PAtIents And Methods study on the same cases. Intraoperatively, patients were divided
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This is a prospective comparative cohort study done at the into two groups according to the laparoscopic appearance of the
Endoscopy Unit of the Woman’s Health Hospital, Assiut, Egypt, FT. If the FT was patent after a chromopertubation test, of normal
between December 10, 2019 and August 20, 2020. It was approved size, length, integrity, external surface, and fimbriae; the patient
by the Assiut Medical School Ethical Review Board (#17101059) was allocated in group A regardless of the existence, extent, and

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