A comparison of treatment for bilateral fimbrial occlusion.

Eighteen patients with bilateral tubal occlusion were divided in an alternating fashion just prior to surgery into two groups for definitive treatment. One group consisted of nine women who underwent a two-stage procedure utilizing a Rock-Mulligan prosthesis; the other nine women underwent terminal salpingostomy utilizing microsurgical technique. Microsurgical technique was defined as the use of microcautery, lavage, and careful handling of tissues; the operating microscope was employed to achieve better visualization and hence better hemostasis and minimized tissue trauma. Both groups received pre-, intra-, and postoperative antibiotics, Decadron, and Phenergan. Hysterosalpingography revealed a patency rate of 89% in the hood group and in the group in which microsurgical technique was used. The term intrauterine pregnancy rates were 22.2% in the hood group (two of nine) and 44.4% in the group in which microsurgical technique was used (four of nine). In this small series there were no ectopic pregnancies or early pregnancy wastage. Subsequently, a series of 54 patients was treated by terminal salpingostomy with an over-all term intrauterine pregnancy rate of 26%. From this study, we conclude that the use of Rock-Mulligan hoods offers no distinct advantage over microsurgical salpingostomy, but has the disadvantage of requiring two surgical procedures.