Recanalization of obstructed fallopian tube by selective salpingography and transvaginal bougie dilatation: outcome and cost analysis.

OBJECTIVE: To investigate effectiveness and cost of transcervical salpingography and recanalization in the management of infertility caused by tubal occlusion. DESIGN: Retrospective analysis of patients investigated with transcervical selective salpingography and, in some instances, treated by transcervical recanalization. SETTING: Four hundred patients with hysterosalpingography diagnosis of obstructed fallopian tubes (clinical environment) are investigated. A repeat hysterosalpingogram after administration of a prostaglandin antagonist demonstrated patency of the tubes in 82 patients and selective transcervical salpingography demonstrated patency in an additional 131 patients. INTERVENTION: Transcervical tubal recanalization. Of the remaining 187 patients, recanalization by transcervical technique was successful in 145 patients. The underlying etiology for tubal obstruction was salpingitis isthmica nodosa in 62, salpingitis and perisalpingitis in 71, endometriosis in 8, failed surgical anastomosis in 43, and undeterminate cause in 3 patients. Pregnancy was attained in 24 patients, there were 10 minor and 1 major complication. OUTCOME MEASURE: Attained and maintained patency of tubes, pregnancy, attendant complications. CONCLUSION: A pregnancy rate of 12.8% was attained after transcervical recanalization of obstructed tubes. An attendant increased rate of pregnancy in patients proven patent after selective salpingography, valuable detailed information about proximal and distal tubes after recanalization of the obstructed proximal tube segment, the low rate of complications, and low cost are factors recommending the use of this technique. Moreover, tubal surgery or IVF treatment are not influenced adversely by prior transcervical tubal recanalization and remain an option for patients who failed to attain pregnancy.

Transcervical recanalization of strictures in the postoperative fallopian tube.

PURPOSE: To evaluate use of transcervical recanalization in patients with reocclusion of the proximal fallopian tube after failed surgery to reverse sterilization or failed tuboplasty to treat inflammatory disease. MATERIALS AND METHODS: The standard technique for transcervical recanalization was attempted in seven patients after failed reversal surgery and in 12 after failed tuboplasty. Four of seven patients with failed reversal surgery had fistular tracts and one also had a stricture; the remaining three patients and all 12 patients treated after failed tuboplasty and tube reimplantation had strictures at the site of implantation or anastomosis. RESULTS: Transcervical recanalization failed in all patients with fistulas but succeeded in 13 of 15 with stenoses. Three patients became pregnant 1-16 months after recanalization and two after in vitro fertilization and embryo transfer. Reocclusion occurred in two of 10 patients reexamined 6-36 months after recanalization. CONCLUSION: Transcervical recanalization is recommended as an alternative to repeat microsurgical reimplantation or tuboplasty.

PIP: Transcervical tubal recanalization was performed in 19 patients in whom previous surgery had failed to reverse sterilization (n=7) or to reconstruct fallopian tubes obstructed from inflammatory disease (n=12). The patients were 25-41 years old, had been infertile for more than 18 months after the failed surgery and had no other clinical cause of infertility. 4 of the cases of failed reversal surgery had fistular tracts, and 1 also had a structure. The other 3 reversal patients and all 12 failed tuboplasty and tube reimplantation patients has strictures at the site of implantation or anastomosis. The standard technique for transcervical recanalization was followed. The transcervical recanalization only succeeded in 13/15 patients with stenoses. 3 of these became pregnant naturally 1-16 months after recanalization and 2 after in vitro fertilization and embryo transfer. Reocclusion occurred in 2 of 10 patients reexamined 6-36 months postoperatively. It was concluded that transcervical recanalization is a suitable alternative to repeat microsurgical reimplantation or to tuboplasty in cases such as these.