Microsurgical repair of the fallopian tubes.

ABSTRACT

PIP: A series of 23 patients undergoing laparotomy for fallopian tube repair between October 1975-December 1981 was reviewed. The patients ranged in age from 22-41, with a mean of 29. 16 of the patients underwent bilateral repair and 7 unilateral. Preoperative assessment of the physical and psychological status of the patient should consider such factors as age, marital status, and previous obstetrical history, as well as fertility of the male partner and the circumstances prompting request for tubal repair. In this series, 14 of 23 patients sought sterilization reversal because of remarriage and desire for more children, 5 had a change of mind and wanted more children in the same marriage and 4 were infertile following previous pelvic inflammation. The status of the fallopian tubes must then be assessed: if the sterilization procedure was via laparotomy and mid-tubal Pomeroy procedure or placement of rings or clips, the prospects for reconstruction are probably good, but the outlook is less favorable if the procedure was by laparoscopy and diathermy. A history of pelvic inflammation or previous tubal surgery reduces the chances for success. Although laparoscopy and hysterosalpingography are often performed preoperatively and can be helpful, laparotomy is the only reliable means of assessing the exact state of the tubes. Microsurgical techniques for tubal assessment and repair are described. The mean operation to conception time was 8 months among those progressing to a successful delivery and about 12 months among those aborting or having an ectopic pregnancy. Postoperative hysterosalpingograms on 11 patients not becoming pregnant within 6 months indicated that 12 tubes remained patent and 8 had again become obstructed. Of the 23 patients undergoing tubal repair, 3 patients were lost to follow-up and 3 had undergone procedures within only 1-4 months, too soon for evaluation. 10 of the remaining 17 had become pregnant, yielding a pregnancy rate of 59% at a mean follow-up time of 27 months. The full-term rate is 41% because of spontaneous abortions and ectopic pregancies. There have been successes following repair both at the mid-tubal level and at the cornual level.