Page 59 - World Journal of Laparoscopic Surgery

Limited Value of Laparoscopy for Diagnosis of Tubal Peristalsis
type of pelvic adhesions. On the other hand, if one or both FTs were Table 1: Basic preoperative data
distended with the dye and showed a characteristic increased tubal Variables Group A (n = 59) Group B (n = 56) p-value
size with distal occlusion (hydrosalpinx), the patient was allocated
in group B. Sustained observation of any rhythmic contractions Age (years) 25.90 ± 5.08 25.96 ± 4.81 0.943
(mean ± SD)
and relaxation of the distal end for 1 minute was done to assess
distal FT peristalsis. If FT was inaccessible, it would be grasped Parity
by atraumatic forceps and kept in place by elevation of the Nullipara 21 (35.6%) 19 (33.9%) 0.851
mesosalpinx of its middle part against the lateral pelvic wall while Para 38 (64.4%) 37 (66.1%)
observing its distal end. At the end of the laparoscopic assessment, BMI (kg/m ) 25.32 ± 4.64 25.59 ± 4.50 0.755
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diagnostic hysteroscopy was done as previously described. To (mean ± SD)
properly visualize the proximal part of the FT by hysteroscopy, all History of PID 5 (8.5%) 27 (48.2%) 0.000*
procedures were done in the follicular phase. The corneal ends
were meticulously evaluated to comment on Darwish hysteroscopic History of operation 18 (30.5%) 26 (46.4%) 0.079
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triad. Darwish hysteroscopic triad is formed of a conical part of Infertility
the FT seen by hysteroscopy. Its base is the ostium, its walls are Primary 22 (37.3%) 20 (35.7%) 0.861
converging first millimeters of the intramural part, and its summit Secondary 37 (62.7%) 36 (64.3%)
is a distal pinhole dark spot representing the narrowest part of Residence
the FT. Darwish hysteroscopic triad was assessed for any anatomic
abnormality and simultaneous visualization of rhythmic opening Urban 32 (54.2%) 30 (53.6%) 0.943
and closing (peristalsis) on maintained intrauterine pressure. Rural 27 (45.8%) 26 (46.4%)
The primary outcome was to estimate distal and proximal FT. *Highly significant
The Statistical Program for Social Science version 24 was used to
analyze the data. Quantitative data were expressed as mean ± SD. paradoxical peristalses of proximal and distal FTs that move in
Qualitative data were expressed as frequency and percentage. The opposite directions to draw sperm and oocyte to the ampulla,
independent-sample t-test (T) and Mann–Whitney U tests were used respectively. 5,14 Intensifying the interface between hormones and
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to compare two means of normally and abnormally distributed nutrients and the eggs or embryos is another role of FT peristalsis,
data, respectively. The Chi-square test was used when comparing which helps with proper fertilization as well as early embryo
nonparametric data. Probability (p-value) < 0.05 was considered development and transportation. 16
significant (S), < 0.001 was considered highly significant and > 0.05 Tubal function assessment in clinical practice is entirely based
7
was considered nonsignificant. All the STrengthening the Reporting on FT patency by various diagnostic techniques. Additionally,
of OBservational studies in Epidemiology (STROBE) guidelines were some studies justified this by pointing out the limited technical
followed during the preparation of the manuscript. accessibility and ethical constraints of invasive tests of tubal
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physiology. Under the influence of several reproductive
hormones, the contractility of circular and longitudinal strips from
results excised FT was evaluated in vitro. However, there were not enough
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According to the laparoscopic status of the FT, two groups of data to compare oviduct ciliary activity to muscle contraction in
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infertile women who underwent concurrent laparoscopic and transit. Trials of FT peristalsis in vivo measurements are rare. For
hysteroscopic evaluations of infertility were studied. Group A example, it was done in some patients who underwent laparotomy
included 59 patients with apparently healthy FTs, while group or tubal occlusion repair. Throughout the whole menstrual cycle,
B included 56 cases with unilateral or bilateral hydrosalpingies they inserted two to three fluid-filled FT catheters to measure
5
(swollen and distally obstructed FT). Sociodemographic information the peristaltic waves. Utilizing straightforward, relevant, and
for both groups is shown in Table 1. Laparoscopic appearance useful technologies, more research on FT peristalsis is urgently
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and chromopertubation tests in both groups are seen in Table 2. required. To the best of our knowledge, this work is the first
Laparoscopic detection of distal tubal peristalsis either in normal or to employ laparoscopy to visualize distal tubal peristalsis in vivo.
hydrosalpingeal FT was low [5 (4.2%) and 5 (4.4%)] in both groups, Due to direct and simple access, laparoscopy is supposed to be
respectively, as demonstrated in Table 3. After the exclusion of cases suitable for this goal. Unfortunately, this study revealed a low rate
with unilateral patent FT from group B, the percentage dropped to of peristalsis in the FT that appeared to be normal and a very low
3.2% (only three FT). Moreover, hysteroscopic detection of proximal rate in the FT that was pathological. This may be attributed to the
tubal peristalsis was significantly higher in group A [80 (67.8%) vs detrimental effects of CO gas on tubal physiology, which may
2
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40 (35.7%)] in total group B. Table 4 shows diagnostic indices of result in the deterioration of the peritoneal (serosal) integrity or
hysteroscopic detection of proximal FT peristalsis in both groups. a general anesthetic impact, including muscle relaxants, which is
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counteracted by regional anesthesia in other studies. Another
possibility is the postmenstrual period timing of all cases, which was
dIscussIon suitable for proper hysteroscopic visualization of the proximal FT
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The FT is a dynamic, paired organ that responds to steroid but not ideal for the observation of the distal section. To determine
hormones and has a sensitive anatomical, physiological, the precise percentage of distal peristalsis induced by progesterone,
neurological, and histologic makeup. To aid in ovum pick-up and another study in the periovulatory period is needed. Without
fertilization, a functional FT should be anatomically patent and scientific support, there is a consensus that distal FT peristalsis
physiologically active. It is interesting to note that there are two would be evident at ovulation to help oocyte pickup. Additionally,

58 World Journal of Laparoscopic Surgery, Volume 16 Issue 1 (January–April 2023)