Comparison of tubal patency and pregnancy rate in microsurgical reanastomosis of rabbit fallopian tube using contact Nd-YAG Laser and suture materials / 대한산부인과학회잡지

OBJECTIVE: Many different methods have been undertaken to increase the success rate of tuboplasty. Ttubal reanastomosis, Nd-YAG laser, splint he development of a new generation of surgical lasers has offered a possibility for the practical use of the laser technique in microsurgical fields. In gynecology, the laser beam has been reported to be a precise instrument for successful tubal surgery with minimal bleeding and postoperative reaction. The authors studied the effect of the infrared laser beam in the area of tubal reanastomosis. METHODS: To compare tubal patency, pregnancy rate, and histologic difference in site of anastomosis, total 120 tubes of 60 rabbits were used for experimental tuboplasty. The study groups were divided according to the kinds of reanastomosis methods. Group I : 1 layer(right tube) and 2 layer(left tube) anastomosis without using splint, group II : 1 layer(right tube) and 2 layer(left tube) anastomosis with using splint, group III : reanastomosis using laser with splint(III-b) and without splint(III-a). RESULTS: 1. The infiltration of inflammatory cell were observed in all group by optical microscopic examination. Group II revealed more fibrotic change and inflammatory cell without significant statistical difference and there was no significant difference between left and right tubes in each group. 2. The tubes of group II were significantly more patent(75%) than that of group I(50%). Especially the patency of group III performed Nd-YAG laser with splint was the highest(90%). 3. The pregnancy rates in groups without splint were 40%(one layer without splint, group I-right tube), 60%(two layer without splint, group I-left tube), 30%(Nd-YAG laser without splint, group III-a), were significantly lower than that of group with splint, 60%(one layer with splint, Group II-right tube), 60%(two layer with splint, Group II-left tube), 80%(Nd-YAG laser with splint, Group III-b). Especially the group IIIb showed the hightest pregnancy rate(80%). CONCLUSIONS: From the above results, it is considered that the tubal reanastomosis using splint and Nd-YAG laser will improve the pregnancy rate and could be the procedure of choice in the future.

A Case of Heterotopic Pregnancy after Tubal Reanastomosis / 대한산부인과학회잡지

Heterotopic pregnancy is the coexistence of intrauterine and extrauterine pregnancy. It is a rare obstetrical phenomenon with an incidence rate about 0.003%. The risk factors of heterotopic pregnancy are IUD, PID, endometriosis, tubal surgery, etc resulting in functional and anatomical injury to tubes. Recently, the wide use of ovulation induction and in vitro fertilization has increased the incidence rate. The clinical manifestation are low abdominal pain, adnexal mass, peritoneal irritation signs, vaginal bleeding, etc. Early detecion of heterotopic pregnancy is very difficult. However, recently, due to development of pelviscopy, ultrasonogram and other diagnostic procedures, the diagnostic rate has increased.Because of the high maternal morbidity and mortality resulted from intraabdominal bleeding after rupture of ectopic pregnacy, immediate termination of ectopic pregnancy is required usually by operative methods. We experienced a case of heterotopic pregnancy after tubal reanastomosis and report this case with a brief review of literatures.

Fertility outcome of Laparoscopic Tubal Reanastomosis / 대한산부인과학회잡지

OBJECTIVE: Our purpose was to evaluate the pregnancy outcome and the advantages of laparoscopic tubal reanastomosis. METHOD: During 16 months, January 1996 to April 1997, thirty-two patient had underwent laparoscopic tubal reanastomosis in Pudang CHA General Hospital. The mean age of the patients was 36.1+/-4.3 years(mean+/-SD; range 26 to 47 years). RESULT: The intrauterine pregnancy rate of laparoscopic tubal reanastomosis was 72.4%(21/29). Data comparing laparoscopic procedure retrospectively to tubal reversal by laparotomy was also evaluated. The mean interval from operation to pregnancy was similar in the two groups (p=0.9). The operation time was sigoificantly longer for laparoscopy (215.3+/-35.5 minutes) than for laparotomy(159.7+/-52.3 minutes). Nevertheless, the intensity of postoperative pain was lower (p<0.05) in patient who underwent laparoscopy than in patient who underwent laparotomy. Also, the mean hospital stay (3.6+/-2.3 days for laparoscopy, 6.1+/-0.5 days for laparotomy) was shortened(p<0.05) after laparoscopy compared with laparotomy. CONCLUSION: Laparoscopic tubal reanastomosis may offer the benefits of lower postoperative pain and shorten recovery time in comparison with laparotomy. Therefore, considering the high pregnancy rate in minimal follow up period of 6 month, laparoscopic tubal reanastomosis could be an alternative procedure to microsurgical laparotomy in patients requesting reversal of sterilization.

Microsurgical Reversal of Tubal Sterilization :A Report on 1,118 Cases / 대한산부인과학회잡지

This study was performed to review and evaluate a series of 1,118 patients who und-erwent microsurgical reanastomosis of previously sterilized fallopian tubes in the 134-month span encompassing January, 1980 to Febrary, 1991 at Seoul National University Hospital. Clinical characteristics of patients, pregnancy rates, and factors influencing the outcome of microsurgical tubal reversal were analyzed. Of 1,118 patients, 633(56.6%) had been sterilized by laparoscopic cautery. Loss of ch- ildren was a leading reason for requesting tubal reversal. The mean interval between tubal sterilization and reversal was 51.9 months. The postoperative tubal length was 6 cm or more in 76.0%. Nine hundred and twenty-two(82.5%) patients were followed up for more than 5 years. Overall pregnancy rate after microsurgical tubal reanastomosis was 54.8%(505 /922) with delivery rate of 71.5%(418/585), and the estimated anatomical success rate was 88.2%(814/922). In 505 pregnant cases, mean age of patients was younger and postoperati- ve tubal length was longer with statistical significance compared with 417 nonpregnant cases. Pregnancy rate was significantly correlated with postoperative tubal length, but not with method and duration of sterilization or operative procedure. These data suggest that only the postoperative tubal length is a factor influencing si- gnificantly pregnancy rate after microsurgical reversal of tubal sterilization.