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At least 19 recordsLinked to original sources
PubMed1982

Endosalpingosis ("endosalpingoblastosis") following laparoscopic tubal coagulation as an etiologic factor of ectopic pregnancy.

Recent literature has suggested that the majority of pregnancies following a laparoscopic tubal coagulation failure are ectopic. This is in direct contrast to the failure of other types of tubal ligation procedures which usually result in intrauterine pregnancies. The purpose of this paper is to explain this disparity in hopes of reducing the chance of ectopic pregnancies. A study of pathology is presented and how different portions of the oviduct respond to coagulation injury is reported. It was found that the endosalpinx of the proximal oviduct, which is so frequently injured during laparoscopic coagulation, becomes activated (endosalpingosis or "endosalpingoblastosis") with potential fistula formation. If the coagulation is more distal only fibrosis occurs. This is clinically significant in that if the laparoscopist avoids injury to the proximal isthmic portion of the oviduct, the chance of "endosalpingoblastosis," fistula, and ectopic pregnancy should be reduced, thus improving the outcome of this technique.

Adult↗
PubMed1993

Development of endosalpingoblastosis and tuboperitoneal fistulas following tubal sterilization: relation with uterine adenomyosis.

A total of 25 consecutive patients who had undergone a tubal sterilization and who were referred for a hysterectomy, were examined by a peroperative methylene blue test of the tubal stumps, and extensive microscopic examination of the uterine wall, cornua and tubal stumps. Eighteen patients had been sterilized by electrocoagulation and 7 by mechanical methods (clips or rings). Tubo- or uteroperitoneal fistulas and endosalpingoblastosis were only observed in the group of patients sterilized by electrocoagulation. The development of tubo- or uteroperitoneal fistulas was correlated with the presence of endosalpingoblastosis and of uterine adenomyosis (P = 0.002 and P = 0.038, respectively). All patients with bilateral fistulas had bilateral endosalpingoblastosis and the only patient with a unilateral fistula had endosalpingoblastosis on the same side. The development of endosalpingoblastosis in patients sterilized by electrocoagulation was correlated with the presence of uterine adenomyosis (P = 0.008). In the same group of patients, a correlation between the length of the proximal tubal stump and the development of utero- or tuboperitoneal fistulas was observed (Wilcoxon test, P = 0.033). Two patients developed an ectopic pregnancy following sterilization. Both patients were sterilized by electrocoagulation, and had endosalpingoblastosis and bilateral fistulas. Our results suggest that the presence of uterine adenomyosis might predispose to the development of endosalpingoblastosis when performing tubal electrocoagulation close to the uterine cornum. We therefore suggest that when performing tubal coagulation, the intact proximal stump should be at least 2 cm.

Adult↗
PubMed1982

There is no place in gynecological endoscopy for unipolar of bipolar high-frequency current.

In 1981 we showed that there is a clear relationship between the extent of destruction of the vascular and nervous systems within the mesosalpinx, and the occurrence of menstrual disorders, and menopausal symptoms. Depending upon the individual sterilization technique, varying portions of the tubes are destroyed and considerable in jury is done to extensive parts of the mesosalpinx. Since two-thirds of the ovarian blood supply passes through the tubal branch of the uterine artery, after destruction of large areas of the mesosalpinx, a marked disturbance of ovarian metabolism must be expected. Using a patient questionnaire, we investigated the effects of the unipolar high frequency current method and the endo-coagulation procedure with respect to late complications. In the years following high-frequency sterilization (in a total of 258 women) 23 women (8.9) were hysterectomized; in the endocoagulation group only 9 patients (2.3%) underwent hysterectomy, primarily for recurrent therapy-resistent menometrorrhagia. Of the women sterilized by the unipolar HF- technique (total number 258) 20 (7.8%) required post-operative curettage 1-3 times while only 8 patients (2.1%) of the endocoagulation group required such a procedure. We found that 79 patients of the HF-group (30.9%) exhibited menstrual disorders compared with only 45 women 11.7% in the endocoagulation group.

Electrocoagulation↗
PubMed1979

Complications of laparoscopic sterilization. Comparison of 2 methods.

A retrospective study of 5346 cases of laparoscopic sterilization with special reference to early and late complications was undertaken. In the 6-year period from 1972 to 1978, 846 patients were sterilized by the elasticized silicone-ring technique and 4500 patients were sterilized by the electrocautery method. The electrocautery method was complicated by electrical burns in 13 cases (0.29%); 3 of these patients required bowel resections. Mechanical complications occurred in 1.6% of the Silastic-ring cases, but none of the patients required additional surgery. The Silastic-ring patients had greater postoperative abdominal pain than the electrocautery patients, but it usually abated within 48 hours. There were 15 cases of postoperative pelvic infection in the electrocautery group, and none in the Silastic-ring group. Bleeding from the mesosalpinx occurred in both groups and occurred more often with coincident suction D&C. Technical failure to perform the sterilization procedure was principally related to previous abdominal surgery. A substantial number of patients complained of menstrual irregularity and/or dysmenorrhea following these sterilization procedures. The majority of women reported unchanged or improved sexual relations. Improvement in sexual relations was reported by significantly more patients in the Silastic-ring group than in the electrocautery group.

Burns, Electric↗
PubMed1978

Myometrial vascular damage after surgical sterilisation by tubal diathermy.

Vascular damage is described in the myometrium adjacent to areas of previous tubal diathermy for sterilisation. Elastosis, different in degree from that seen in the multiparous uterus, is most common, but more striking is medial arteriolar muscle loss with microaneurysm formation and occasional rupture.

Aneurysm↗
PubMed1977

The snare method of laparoscopic sterilization: an analysis of 1,000 cases with 4 failures.

The snare method has proven to be an effective method of tubal resection for sterilization. In the most experienced hands, significant complications are indeed rare. However, the failure rate appears to be higher than that of the coagulation-alone method, at least in the postabortal patient. The necessity for pathologic confirmation, a tradition of surgery, is critically questioned. Additional coagulation of the tubal ends after resection is now recommended, especially in the patient seeking abortion as well as sterilization. The authors await the comparative long-term results of bipolar forceps and the newer mechanical methods of laparoscopic tubal sterilization. It is conceivable that the snare and other unipolar electrosurgical instruments designed for female sterilization will become obsolete.

Adolescent↗
PubMed1977

[Sterilization by partial resection of the oviducts via bipolar electrocoagulation (author's transl)].

A total of 2,357 sterilizations via bipolar coagulation was effected at the University Clinics of Gynecology at Basel and Tübingen since 1972 and 1975 respectively. Of these, 2,143 were effected via laparoscopy. The following complications occurred which required laparotomy: in two cases, hemorrhages from the abdominal cavity as a result of the second puncture, in one case from the mesosalpinx, and, as a late complication, two extrauterine pregnancies. The method failed in the case of the two extrauterine pregnancies and possibly also in the case of two doubtful intrauterine pregnancies (0.8--1.7 per thousand). Today this surgical measure is being performed in Tübingen exclusively by the single-puncture technique an increasingly under local anesthesia. The advantages of the method are an accurately determinable coagulation zone, sparing of the mesosalpinx, low incidence of complications, absence of life-threatening incidents, and low failure quota.

Anesthesia, Local↗