Laparoscopic-assisted tubal anastomosis.

STUDY

OBJECTIVE

To determine the length of procedure, length of hospital stay, complications, and postoperative pregnancy rates of traditional tubal anastomosis (TA) and laparoscopic-assisted TA (LATA).

DESIGN

A comparison of 8 women undergoing LATA with 11 patients operated on by the same surgeon during a similar time period who were not candidates for, or did not desire, a laparoscopic approach.

SETTING

Academic practice tertiary care setting.

PATIENTS: Women requesting reversal of tubal ligation.

INTERVENTIONS: Tubal anastomosis by laparoscopy or laparotomy.

MEASUREMENTS AND MAIN

RESULTS

Patients undergoing the two procedures did not differ by age or parity, although those selected for LATA had a lower body mass index (23.2 +/- 1.4 vs 30.8 +/- 2.0 kg/m2, p = 0.01). Although the LATA took longer (251 +/- 14 vs 194 +/- 10 min, p = 0.004), hospital stay was significantly shorter than for traditional TA (1.8 +/- 0.3 vs 3.0 +/- 0.1 days, p = 0.004). Of the eight LATAs, six were completed and two were converted to laparotomy. For all patients with follow-up, clinical pregnancy rates were 43% and 29% (NS) for TA and LATA, respectively, with 100% of the former and 80% (NS) of the latter group who did not conceive having at least one patent tube on hysterosalpingogram.

CONCLUSIONS

Laparoscopic-assisted TA is a possible alternative to the traditional TA performed by laparotomy. Ideal candidates for LATA appear to be women without obesity and with proximal tubal segments of 3 cm or greater. Larger studies with longer follow-up will define appropriate candidates and identify long-term results.