MICROSURGICAL SALPINGOSTOMY IS NOT AN OBSOLETE PROCEDURE

Objective - A review of the results of microsurgery for bilateral distal tubal blockage. Design - A retrospective review. Setting - Hammersmith Hospital London and local private hospitals. Subjects - 388 patients with bilateral ampullary occlusion treated between 1971 and 1988 by microsurgery. Interventions - Full investigation for other causes of infertility followed by abdominal microsurgical salpingostomy. Repeated meticulous follow-up was essential with check laparoscopy one year after surgery. Main outcome measure - Successful pregnancy in relation to tubal damage. Results - In 65 women microsurgery followed tubal reocclusion after failed conventionally performed salpingostomy. 74 women (23%) had one term pregnancy after primary salpingostomy and 12 women (18%) after repeat salpingostomy. Over half the women having a term pregnancy subsequently had a second infant. The tubal damage was classified in four stages according to the degree of mucosal damage and tubal fibrosis, the presence of isthmic disease and the quality of tubal and ovarian adhesions. Approximately one quarter of patients had stage I disease and amongst these 39% had babies after primary salpingostomy and 25% after repeat salpingostomy. Conclusion - Microsurgical salpingostomy is a specialized procedure. Proper selection of patients, competent microsurgical technique and adequate follow-up appear crucial to success. In selected patients treatment by salpingostomy gives better results than multiple cycles of in vitro fertilization.