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  • Title: Is microsurgery necessary for salpingostomy? The evaluation of results.
    Author: Winston RM.
    Journal: Aust N Z J Obstet Gynaecol; 1981 Aug; 21(3):143-52. PubMed ID: 7036983.
    Abstract:
    The role of microsurgery in salpingostomy has been the subject of disagreement among infertility surgeons. However, various studies have suggested that the microscope is useful in tubal anastomosis after sterilization by ligation, fulguration or clip application. In the world literature, 560 cases of microscopic reversal have been reported with a success rate of 56% live births and 3% ectopic pregnancies (Population Reports, 1980). The microscope has also been found to be superior to loupes for tubal anastomosis. Assessment of the effectiveness of the microscope in improving treatment depends on the following factors: 1) reasonably standardized methods for selecting patients; 2) disease classification; 3) surgical procedure; 4) follow-up assessment; and 5) reporting of results. In 14 series of salpingostomy by conventional methods during the period 1964-1978, overall term pregnancy rate was 9.5%; 18% of the pregnancies ended in miscarriage and 27% were ectopic. Various methods were used, as were adjuncts such as steroids promethazine. However, these differences did not contribute significantly to the outcomes. At Hammersmith Hospital between 1960-71, 9.5% of 150 patients had term pregnancies after bilateral salpingostomy. 3 major published series of salpingostomy by microsurgery using hydrotubation and postoperative steroid therapy showed substantial improvement over the macrosurgical series. Term pregnancy rates ranged from 17.5% to 22%; ectopic pregnancy rates from 9.5% to 18% and abortion rate from 4 to 7.5%. A comparison of the micro- and macrosurgery studies suggest that: 1) the percentage of term pregnancies is more or less double in microsurgical series; 2) tubal patency is substantially higher after microsurgery and this is in favor of a more refined approach; and 3) the results with either technique for salpingostomy are currently dismal and indicate little capability of improvement, suggesting the need to improve methods of prevention of tubal damage; achieving earlier diagnosis of disease; and pursuing alternative treatments. Potential refinements in the management of hydrosalpinx (tubal biopsy; electrical activity; measurements of transport of surrogate ova; tubal fluid; epithelial generation laser surgery; transplantation and in vitro fertilization) are discussed.
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