Surgical management of distal tubal occlusion.

During the 9-year period ending April, 1985, 103 women had bilateral and unilateral cuff salpingostomy at the University of Virginia Hospital. Currently accepted principles of microsurgery were used as well as an "antiadhesion" regimen consisting of intravenous dexamethasone and antibiotics, intraperitoneal dextran, and postoperative hydrotubations. The postoperative tubal patency rate was 75.6% in tested patients (91.2% in patients known to have conceived). Forty women (38.8%) conceived and 26 (25.2%) have had one or more term pregnancies. Fourteen women (13.5%) had ectopic pregnancies but three of these have also had term pregnancies. Fourteen women (13.5%) had first-trimester abortions. Two of nine women who had repeat salpingostomies have carried pregnancies to term as have two of 10 women who had ampullary salpingostomies. The extent of tubal disease remains the single most important factor with regard to subsequent successful pregnancy.