Comparison of Pregnancy Outcome According to the Types of Tuboplastic Surgery for Correction of Tubaland Peritoneal Infertility

Lee, Kyu Sup; Park, Chul Hee

Abstract

From January, 1988 to December, 1994, 336 cases of tuboplastic surgery were performedfor the purpose of restoration of fertility at the Department of Obstetrics and Gynecology,Pusan National University Hospital. Of these 336 cases, 269 cases were followed-up for 36months postoperatively and reviewed for evaluation and comparison of pregnancy rate andfactors influencing pregnancy outcome according to the types of surgical procedure performed.Six types of surgical procedures were performed : salpingolysis, tubal reanastomosis, tubalimplantation, fimbrioplasty, neosalpingostomy, and combined procedure.The results for the 269 cases were as follows:1. The distribution of tuboplastic surgery was 38 cases(14.1%) for salpingolysis, 142(52.85) for tubal reanastomosis, 5(1.9%) for tubal implantation, 15(5.6%) for fimbrioplasty,45(16.7%) for neosalpingostomy, and 24(8.9%) for combined procedure.2. One hundred forty-eight(55.0%) of 269 patients who underwent tuboplastic surgeryconceived postoperatively. The pregnancy rate was 44.7%(17/38) for salpingolysis, 71.8%(102/142) for tubal reanastomosis, 20.0%(1/5) for tubal implantation, 26.7%(4/15) for fimbrioplasty,24.4%(11/45) for neosalpingostomy, and 54.2%(13/24) for combined procedure.3. The term pregnancy rate was 37.5%, the ectopic pregnancy rate was 5.6%, and thespontaneous abortion rate was 8.6% in patients who underwent tuboplastic surgery.4. Among one hundred forty-eight conceived cases, one hundred twenty-six pregnancies(85.1%) occurred during the first 21 months after surgery, and almost all pregnancies wereachieved before 24 months postoperatively. The mean interval from surgery to conception was11.1 months.5. On tubal reanastomosis, 1) Concerning the site of anastomosis, the pregnancy rate was higher in the isthmic-isth-mic(87.5%) than in other groups. 2) In patients whose postoperative tubal length was less than 3cm, pregnancy was notachieved. 3) Statistically significant differences were not found in the pregnancy rates followingmicro-and macro-surgery for tubal reanastomosis(p > 0.05). 4) There were no statistically significant differences between the pregnancy ratesfollowing unilateral and bilateral surgical procedures for tubal reanastomosis(p > 0.05). 5) The pregnancy rate was statistically higher in patients who underwent tubal ligationwith ring than with electrocautery(p < 0.05). 6) There were no statistically significant differences between the pregnancy ratesaccording to the duration of sterilization(p > 0.05).6. Distal tubal obstruction treated by neosalpingostomy resulted in pregnancy rates thatwere higher with mild disease than with moderate or severe disease(p < 0.05).