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At least 19 recordsLinked to original sources

PubMed1993

Comparison of persistent ectopic pregnancy after laparoscopic salpingostomy versus salpingostomy at laparotomy for ectopic pregnancy.

OBJECTIVE: To compare persistent ectopic pregnancy after laparoscopic salpingostomy versus salpingostomy at laparotomy for the treatment of intact ampullary ectopic pregnancy. METHODS: We reviewed the medical records of 157 patients who had undergone salpingostomy for intact ampullary ectopic pregnancy at Yale-New Haven Hospital between September 1, 1986 and August 31, 1991. One hundred three women had laparoscopic salpingostomy and 54 had salpingostomy at laparotomy. RESULTS: Sixteen of 103 women (15.5%) undergoing laparoscopic salpingostomy were treated for persistent ectopic pregnancy, in contrast to one of 54 women (1.8%) who had salpingostomy by laparotomy. The adjusted odds ratio for persistent ectopic pregnancy after laparoscopic salpingostomy versus salpingostomy at laparotomy for an intact ampullary ectopic pregnancy was 8.4, with 95% confidence interval 1.1-62 (P < .02). Stepwise logistic regression demonstrated that a laparoscopic approach to salpingostomy (P < .05), smaller ectopic size (P < .01), and fewer days of amenorrhea (P < .05) predicted persistent ectopic pregnancy. CONCLUSION: Persistent ectopic pregnancy is more likely after laparoscopic salpingostomy than after salpingostomy at laparotomy for intact ampullary ectopic pregnancy.

Cohort Studies↗

PubMed1980

Surgery-pregnancy time intervals after salpingolysis, unilateral salpingostomy, and bilateral salpingostomy.

Pregnancy rates and time intervals to achieve pregnancy were determined in 144 patients treated for infertility by lysis of bilateral tubal or peritubal adhesions. The pregnancy rate after bilateral salpingostomy for hydrosalpinges was low (18.7%; n = 91). The eventual pregnancy rate after unilateral salpingostomy with bilateral division of adhesions (43.8%; n = 16), however, was comparable to that after bilateral salpingolysis for purely peritubal adhesions (54.1% n = 37). In contrast, the mean surgery-pregnancy time interval was substantially longer after unilateral salpingostomy (104 weeks) than after bilateral salpingolysis (45 weeks) (P < 0.01). These findings indicate that salpingo-oophorectomy may be preferable to salpingostomy for unilateral hydrosalpinx.

Adnexal Diseases↗

PubMed1997

Randomised trial of systemic methotrexate versus laparoscopic salpingostomy in tubal pregnancy.

BACKGROUND: Laparoscopic salpingostomy is a well-established treatment for patients with tubal pregnancy who desire to retain fertility. Another approach that preserves the fallopian tube is medical treatment. We compared systemic methotrexate and laparoscopic salpingostomy in the treatment of tubal pregnancy. Outcome measures were treatment success, tubal preservation, and homolateral tubal patency. METHODS: Between January, 1994, and September, 1996, haemodynamically stable patients with laparoscopically confirmed unruptured tubal pregnancy and no signs of active bleeding were randomly assigned systemic methotrexate (four 1.0 mg/kg doses of intramuscular methotrexate alternated with 0.1 mg/kg oral folinic acid) or laparoscopic salpingostomy. Treatment success was defined as complete elimination of the tubal pregnancy (serum human chorionic gonadotropin < 2 IU/L) and preservation of the tube. Homolateral tubal patency was assessed by hysterosalpingography. Analysis was by intention to treat. FINDINGS: 100 patients were included in the trial. Of 51 patients allocated systemic methotrexate, 42 (82%) were successfully treated with one course; two (4%) patients needed a second course for persistent trophoblast. Surgical intervention was needed in seven (14%) patients; salpingectomy was necessary in five of these patients for tubal rupture. Of the 49 patients allocated laparoscopic salpingostomy, 35 (72%) were successfully treated by laparoscopic salpingostomy alone; salpingectomy was needed in four (8%) patients, and ten (20%) needed methotrexate for persistent trophoblast. The tube was preserved in 46 (90%) patients in the methotrexate group versus 45 (92%) in the salpingostomy group (rate ratio 0.98 [95% CI 0.87-1.1]). Homolateral tubal patency could be assessed in 81 patients: the tube was patent in 23 (55%) of 42 patients in the methotrexate group and in 23 (59%) of 39 patients in the salpingostomy group (rate ratio 0.93 [0.64-1.4]). INTERPRETATION: In haemodynamically stable patients with unruptured tubal pregnancy, systemic methotrexate and laparoscopic salpingostomy were successful in treating the majority of cases. We found no significant difference between the treatments in the homolateral patency rate. Subsequent fertility outcome has to be awaited to show which treatment yields better fertility prospects.

Adult↗

PubMed1991

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.

Adult↗

PubMed1993

Comparison of a local injection of hyperosmolar glucose solution with salpingostomy for the conservative treatment of tubal pregnancy.

OBJECTIVE: To compare a local injection of hyperosmolar glucose and salpingostomy for the laparoscopic treatment of tubal pregnancy in terms of immediate success and postoperative tubal patency. DESIGN: Prospective. PATIENTS, SETTING: Forty women with an unruptured tubal pregnancy were enrolled from among 117 women with ectopic pregnancies (EPs) admitted consecutively to the university clinic. The inclusion criteria were as follows: [1] concentration of beta-hCG in the serum < or = 5,000 IU/L; [2] no living fetus in the EP; and [3] unruptured tubal pregnancy at laparoscopy. INTERVENTIONS: After randomization, 20 of these patients were treated with a local injection of hyperosmolar (50%) glucose solution and 20 women by salpingostomy. Tubal patency was evaluated at relaparoscopy or by hysterosalpingography 6 to 13 months after the primary treatment. RESULTS: The mean decrease in beta-hCG concentration from the preoperative value to the first postoperative day was 37% and 52% in the glucose and salpingostomy groups, respectively, and the mean resolution time was 13 and 12 days, respectively. Human chorionic gonadotropin showed a persistent EP in 4 women (20%) in the glucose group and 2 (10%) in the salpingostomy group. A patent treated tube was found in 9 of 13 women in the glucose group and 9 of 10 in the salpingostomy group at re-examination. During a follow-up of 6 to 20 months 4 women in the glucose group and 4 women in the salpingostomy group had an intrauterine pregnancy. CONCLUSION: A local injection of hyperosmolar glucose is a reasonable method treating tubal pregnancy in selected cases but does not seem to offer any advantage over salpingostomy concerning persistent trophoblastic disease rate.

Adult↗

PubMed1978

Factors influencing the success of salpingostomy techniques for distal fimbrial obstruction.

The present study reviews the pregnancy outcome of 99 patients treated with salpingostomy techniques for distal fimbrial obstruction. Eighty-seven patients were treated with terminal salpingostomy, 10 with medioampullary salpingostomy, and 2 with isthmic salpingostomy. The pregnancy rates were 28%, 20%, and 0%, respectively. Within the terminal salpingostomy group, 5 of 18 patients treated with a prosthesis conceived, for a pregnancy rate of 28%. Nineteen of the 69 patients treated with an eversion technique conceived, for a pregnancy rate of 28%. No advantage with the use of a terminal prosthesis could be demonstrated. Tubal disease treated with techniques of salpingostomy was categorized according to a classification incorporating the several prognostic factors thought to influence subsequent conception. The pregnancy rate was found to be in direct relationship to the extent of tubal disease and pelvic adhesion formation. The tubal patency rate decreased in direct relationship to the extent of disease. The use of postoperative hydrotubation did not appear to improve the conception rate after salpingostomy for distal fimbrial obstruction.

Actuarial Analysis↗

PubMed1996

Comparison of local injection of methotrexate and linear salpingostomy in the conservative laparoscopic treatment of ectopic pregnancy.

STUDY OBJECTIVE: To compare local injection of metothrexate (MTX) and linear salpingostomy in the conservative laparoscopic treatment of ectopic pregnancy. DESIGN: Prospective, nonrandomized study, July 1991 to May 1994. SETTING: Department of obstetrics and gynecology in a university hospital. PATIENTS: Fourteen women with unruptured ectopic pregnancies without documented fetal heart motion and size below 50 mm as measured by ultrasound. INTERVENTIONS: All 14 women underwent the laparoscopic treatment by either local injection of MTX or linear salpingostomy (7 patients each). MEASUREMENTS AND MAIN RESULTS: Both treatments were successful in all patients. Mean length of operation was 32 +/- 5 minutes (range 25-35 min) in the MTX group versus 67 +/- 15 minutes (range 50-90 min) in the salpingostomy group. Mean length of hospital stay was 2.7 days (range 1-5 days) and 1.7 days (range 1-3 days), respectively. No intraoperative complications occurred, and the postoperative course was uneventful in all women. Mean disappearance time of serum beta-human chorionic gonadotropin (hCG) levels was similar in both groups, although in the linear salpingostomy group the decrease was immediate. No difference in tubal patency on follow-up hysterosalpingography was observed between the two groups. CONCLUSIONS: Although this is a preliminary report with a small number of patients, both types of treatment were safe and effective. An advantage of linear salpingostomy was the predictable and consistent decline of circulating beta-hCG, and consequently a reduced need for a close follow-up. Local MTX injection was safe, economic, effective, and easy to perform, and in our experience the surgical time was statistically shorter than that for linear salpingostomy. Therefore, in selected patients, local injection of MTX could be the treatment of choice for unruptured ectopic pregnancy, avoiding a longer and potentially more dangerous procedure. Long-term outcomes do not seem to differ between the two types of treatment.

Adult↗

PubMedDate not supplied

Fertility after salpingostomy following mechanically produced hydrosalpinx in rabbits.

Microsurgical salpingostomy results in 90% of tubes remaining patent following surgery. Although pregnancy rates have improved to a slight extent, the percentage of patients having live babies after salpingostomy is still disappointing. The discrepancy between patency rates and pregnancy rates seems to be due mainly to long standing tubal damage after the original infection. Possibly, raised intraluminal pressure from accumulated fluid may be a factor. Mechanically produced hydrosalpinges in rabbits show similar morphological characteristics to human hydrosalpinges (Vasquez et al., 1981, Otubu et al., 1984). This rabbit model was used in this study to examine the relationship between the severity of these changes and fertility after salpingostomy. Mechanical hydrosalpinges were produced in thirty mature New Zealand white rabbits by double clip application. After a period varying from 8 to 52 weeks of clip application, cuff salpingostomy and ampullary-isthmic anastomosis was done. One week after surgery, the animals were mated with bucks of proven fertility. There were pregnancies in all the uterine horns on the unoperated side (control) in all animals. There were pregnancies on the operated side in only two animals giving a pregnancy rate of 6.7%. A total of sixteen tubes were patent out of thirty operated, giving a patency rate of 53.3%. Adhesion was a major problem. We conclude that fertility is reduced after salpingostomy in mechanically produced hydrosalpinges in rabbits. The significance of this finding is discussed.

Animals↗

PubMed1995

Is salpingostomy the surgical treatment of choice for unruptured tubal pregnancy?

Salpingostomy has gradually replaced salpingectomy as the surgical procedure of choice for unruptured tubal pregnancy in women who wish to preserve fertility. There are no prospective studies and only a few retrospective reports comparing fertility rates after salpingostomy and salpingectomy. Three major retrospective studies found no significant difference in fertility or incidence of repeat ectopic pregnancy between the two procedures, but salpingostomy carries a 5-8% risk of persistent ectopic pregnancy, contributing to increased morbidity and cost. There are approximately 109,000 ectopic pregnancies per year in the United States. If half are treated by salpingostomy, 54,500 women will need serial beta-hCG testing after surgery. Approximately 3543 will have a persistent ectopic pregnancy requiring surgical or medical treatment. The additional direct costs created by persistent ectopic pregnancy is estimated to be almost $16,000,000. Fertility after ectopic pregnancy is affected much more by the status of the contralateral tube than by the procedure performed, with fertility rates exceeding 80% after salpingectomy when the opposite tube is normal. By performing salpingectomy when the contralateral tube is normal, half the additional cost and morbidity could be avoided without jeopardizing subsequent fertility.

Costs and Cost Analysis↗

PubMed1996

Laparoscopic salpingostomy versus laparoscopic local methotrexate injection in the management of unruptured ectopic gestation.

OBJECTIVE: Our goal was to determine whether laparoscopic salpingostomy is preferable to laparoscopic methotrexate injection in the management of unruptured tubal gestation. STUDY DESIGN: Forty-eight patients with unruptured tubal pregnancy were prospectively randomized to either laparoscopic salpingostomy or laparoscopic local methotrexate injection in a university medical center. Operation time, duration of hospital stay, decrease in levels of beta-human chorionic gonadotropin, and fertility outcome were compared between the two groups. RESULTS: The salpingostomy group had a longer operative time (p < 0.0001) but a shorter hospital stay (p < 0.01) and a lower incidence of persistent trophoblastic activity (5% vs 14%), although this difference did not reach statistical significance. The time interval until beta-human chorionic gonadotropin disappearance was similar (13.9 and 13.7 days), and the subsequent intrauterine pregnancy rate was similar in the two groups (83.5% and 81%). One repeat tubal pregnancy occurred in the salpingostomy group. CONCLUSIONS: Both these methods of conservative management are equally effective and each one has its merits.

Chorionic Gonadotropin, beta Subunit, Human↗

PubMed1990

Persistent ectopic pregnancy following laparoscopic linear salpingostomy.

As the surgical approach for ectopic pregnancies evolves from radical to conservative procedures, the potential hazard of persistent ectopic pregnancy has become increasingly pertinent. From September 1, 1986 to August 31, 1989, 11 women with persistent ectopic pregnancy after laparoscopic salpingostomy were diagnosed and treated at Yale-New Haven Hospital. Persistent ectopic pregnancy was suspected in nine cases because of symptoms and in two because of plateauing beta-hCG titers. Ten of 11 patients underwent repeat surgery. Eight had partial or complete salpingectomy of the involved ipsilateral tube, two had repeat salpingostomies, and one was treated with methotrexate. When the 11 women with persistent ectopic pregnancies were compared with 70 patients treated successfully by laparoscopic salpingostomy using multivariate stepwise logistic regression, smaller size of the ectopic (P less than .01) and fewer days of amenorrhea (P less than .05) predicted persistent ectopic pregnancy after laparoscopic salpingostomy. Based upon our experience, we believe that earlier-treated ectopic pregnancies (ie, fewer than 42 days of amenorrhea) and/or smaller ectopics (ie, 2.0 cm or less in diameter) require treatment with particular caution and close postoperative surveillance.

Chorionic Gonadotropin↗

PubMed1986

Treatment of persistent trophoblastic tissue after salpingostomy with methotrexate.

Salpingostomy has become a common treatment of unruptured ectopic pregnancies. A complication of salpingostomy is persistent trophoblastic tissue. All reported cases to date of salpingostomy with persistent trophoblastic tissue have required salpingectomy. We reported a case of persistent trophoblastic tissue after salpingostomy treated successfully with methotrexate.

Adult↗

PubMed1994

Pregnancy rates after operative endoscopic treatment of total (neosalpingostomy) or near total (salpingostomy) distal tubal occlusion.

OBJECTIVE: To determine the efficacy of the endoscopic treatment of complete distal tubal occlusion or moderate to severe tubal phimosis and to analyze outcome using contemporary statistical methodologies. DESIGN: Prospective cohort analysis. SETTING: Tertiary-care institution. PATIENTS: One hundred thirteen consecutive patients undergoing a neosalpingostomy or salpingostomy. INTERVENTIONS: KTP/532 laser (Laserscope, Santa Clara, CA) laparoscopy. Additional infertility factors were treated postoperatively. MAIN OUTCOME MEASURES: Crude pregnancy rate (PR), monthly fecundity rate, monthly probability of pregnancy, cure rate, and cumulative PRs. Outcome was compared on the basis of the surgical procedure performed. The impact of endometriosis as well as other fertility factors was analyzed. RESULTS: Twenty-three patients conceived yielding a crude PR of 20.4%, a monthly fecundity rate of 2.6%, a monthly probability of pregnancy of 6.4%, and a cure rate of 52.4%. There were six ectopic pregnancies (5.3%). A significant difference was found among the cumulative pregnancy curves. The cumulative pregnancy curve for unilateral salpingostomy differed significantly from that of unilateral neosalpingostomy. Patients with endometriosis and no other infertility factors had a significantly better cumulative pregnancy curve compared with patients without endometriosis or other factors as well as compared with patients with no endometriosis but with other infertility factors. Patients undergoing bilateral neosalpingostomy had a cure rate of 9.0% whereas patients undergoing bilateral salpingostomy had a cure rate of 34.2%. CONCLUSIONS: Operative endoscopy yields PRs that are comparable to those reported in the literature for laparotomy. The presence of complete bilateral distal tubal occlusion has a negative impact on outcome.

Adult↗

PubMed1991

The intussusception salpingostomy technique for the therapy of distal oviductal occlusion at laparoscopy.

A new technique of salpingostomy by laparoscopy for treatment of distal oviductal occlusion is described. This technique uses sharp dissection and can be performed rapidly. The intussusception salpingostomy is undertaken by making a relatively short incision in the hydrosalpinx and then prolapsing the tubal mucosa through this neostium. The borders of the incision thus act as a restrictive collar to maintain the mucosa in this newly everted configuration. In a series of 40 women subjected to this procedure, 22 were followed for more than 12 months postoperatively; the term pregnancy rate was 22.7%. This fertility is similar to that after salpingostomy by microsurgical laparotomy.

Adult↗

PubMed1991

Linear salpingostomy for ectopic pregnancy.

Linear salpingostomy is the procedure of choice for management of uncomplicated ectopic gestations if certain constraints are met. The procedure is straightforward and may be performed by laparotomy. However, laparoscopic salpingostomy is becoming the preferred approach. Additionally, laparoscopy decreased operative time, hospital stay, and patient recovery time. Postoperatively, patients should be observed with weekly assessment of beta-hCG titers to ensure complete resorption of any viable trophoblast. Failure of resorption may result in a persistent ectopic pregnancy. Reproductive outcome is preserved in most patients, with intra-uterine pregnancy rates that approach 60%. Recurrent ectopic gestation rates of 15% are acceptable in view of subsequent close surveillance in women who have undergone previous salpingostomies, which also facilitates earlier diagnosis.

Fallopian Tubes↗

PubMed1995

[Pelviscopic salpingostomy with everted suture].

From 1987 to 1990 pelvioscopic distal salpingostomy was performed in 47 patients at the University Hospital of Kiel. The tubal mucosa was everted and fixed with 4/0 PDS sutures. 35 patients (74%) responded to a questionnaire 2-4 years after surgery. A bilateral salpingostomy had been performed in 16 of these 35 cases, while the contralateral tube was either absent or intramurally occluded in 19 cases. Eight patients (23%) postoperatively had an intrauterine pregnancy, five patients gave birth to a healthy child, one patient was pregnant at time of follow-up. Three patients had abortions and three experienced a tubal pregnancy of one or both sides. Compared to the endoscopic procedure with the CO2 laser pelvioscopic salpingostomy with an everted suture represents an equally suited alternative.

Adult↗

PubMed1984

Ciliogenesis following salpingostomy of rabbit hydrosalpinges.

Twenty-five artificially induced hydrosalpinges were studied in New Zealand white rabbits. Hydrosalpinges had been created after 2-16 wk occlusion of both the fimbrial end and the ampullary isthmic junction (A.I.J.), using either Ethilon 8/0 or tantalum clips. Their diameters ranged from 4 to 12 mm, being larger in the clipped oviducts. In hydrosalpinges larger than 6 mm diameter, a salpingostomy was done and ampullary biopsies were taken and prepared for scanning electron microscopy, and 1-micron sections and ultrathin sections for transmission electron microscopy. The changes observed were those found in previous work (Vásquez et al., 1981). Post-salpingostomy biopsies were taken from 10 patent oviducts at different intervals of time, ranging from 2 days to 8 wk. Ciliogenesis was observed between the 2nd and 3rd wk after salpingostomy.

Animals↗

PubMed1983

Pregnancy following salpingostomy: comparison between CO2 laser and electrosurgery procedures.

The purpose of this study was to investigate the value of the CO2 laser in tubal surgery. The results of CO2 laser and electrosurgery procedures in salpingostomy were compared. From January 1977 through December 1978, 30 salpingostomies were carried out by electrosurgery. From January 1979 through January 1981, 38 salpingostomies were carried out by CO2 laser. All cases were performed using a microsurgical approach by the same two surgeons. The results for both groups were analyzed and compared. Despite a slight improvement in the term pregnancy rate with the use of the CO2 laser, no statistically significant difference was found between the two procedures in this series. The CO2 laser's ability to cut bloodlessly through tissue with minimal damage allows all procedures of tuboplasty and results in surgery easily and quickly achieved. This experience suggests that the CO2 laser now represents a safe and effective alternative to electrosurgery in tubal microsurgery.

Adult↗