A comparison between laser surgery and electrosurgery for bilateral hydrosalpinx: a 2-year follow-up. Salipingostomy: results of two different methods of treatment. Pregnancy outcome in neosalpingostomy by the cuff vs Bruhat technique using the carbon dioxide laser. Three comparative techniques on tubo-plasty. Comparison of the operating microscope and loupe for microsurgical tubal anastomosis: a randomized clinical trial.
The overall pregnancy rate after salpingostomy in women with complete bilateral terminal tubal occlusions was 26.9%. No difference was found in the intrauterine pregnancy rate and the surgery-conception interval between salpingostomy with the CO2 laser or the microdiathermy needle at a 2-year follow-up. The advantage of the CO2 laser in other reproductive surgery remains to be seen. nan Distal tubal occlusion is one of the most challenging conditions that the reproductive surgeon faces in the management of tubal disease. This study was designed to compare the pregnancy rates between two well-known techniques for tuboplasty using the carbon dioxide laser from March 1982 to October 1988. Alternate infertility patients with distal tubal occlusion were assigned to either a cuff or Bruhat technique. Only patients with bilateral hydrosalpinges and no other infertility factors qualified for this study. Nineteen patients had a cuff neosalpingostomy, and 15 patients had a Bruhat neosalpingostomy. Two patients who were assigned to the Bruhat technique had to be changed to the cuff technique because of technical problems. The mean age and length of infertility were similar in both groups. Six patients in the cuff group (31.6%) and 5 (33.3%) in the Bruhat group conceived. One ectopic pregnancy occurred in each group. This study shows that both techniques produce similar pregnancy rates. The Bruhat technique is considerably faster but cannot be applied adequately when the fallopian tubes have thick walls. nan Reversal of sterilization was performed by microsurgical tubal anastomosis in 72 women using either loupe (n = 36) or microscope (n = 36). The study design called for the randomization of patients within pairs, which were matched for method of sterilization and site of anastomosis. A significant difference between methods could not be demonstrated at 12 months (P = 0.39) or 24 months (P = 0.37) after the procedure.
From these limited data there is no evidence of benefit or disadvantage of tubal surgery versus no treatment or alternative treatments. Likewise there is no evidence of advantage or disadvantage of using microsurgery over standard techniques; laparoscopic approach over laparotomy; the use of CO2 laser; or electrocoagulation over thermocoagulation. Randomised controlled trials should be undertaken to determine the role of tubal surgery versus no treatment or alternative treatments. Randomised controlled trials should be undertaken to determine the role at tubal surgery of magnification, laparoscopic approach, the use of lasers or electrocoagulation.