[Distal tubal surgery: a critical review of 104 laparoscopic distal tuboplasties].

MATERIALS AND

METHODS

Between January 1988 and June 1993, laparoscopic distal tuboplasty was carried out on 104 patients. The mean age of the patients was 32 years: the duration of infertility was 3.2 years; infertility was primary for 44 patients (42.3%) and secondary for 60 patients (57.7%). The patients were classified according to the French cooperative tubal scoring system: stage 1: 21 patients, stage II: 49 patients, stage III: 22 patients, stage IV: 12 patients; 37 patients underwent a fimbrioplasty (35%) whereas 67 patients underwent a neosalpingostomy (65%). No complications were observed either during or after the operation. All patients were discharged two or three days after the operative procedure. Antibiotic and antiinflammatory treatments were systematically administered post-operatively.

RESULTS

Thirty-four patients obtained intrauterine pregnancies (32.5%) and 5 patients obtained ectopic pregnancies (4.8%); 76% of the intrauterine pregnancies were obtained within the 1st postoperative year. The pregnancy outcome was directly correlated to the tubal scoring system. Intrauterine pregnancy rate decreased with the severity of the tubal damage: stage 1: 12/21 (57%), stage II: 19/49 (38.7%), stage III: 3/22 (13.6%), stage IV: 0/12.

CONCLUSION

Laparoscopic surgery represents the first-choice treatment of distal tubal occlusion in stage I and II. In stage IV, IVF should be suggested immediately. In stage III, the choice of treatment is more difficult: the main prognostic factor might be the tubal mucosal appearance.