Hysteroscopic cannulation for proximal tubal obstruction: a change for the better?

OBJECTIVE

To compare overall the results of hysteroscopic tubal cannulations and resection anastomosis for proximal tubal occlusion.

DESIGN

Nonrandomized retrospective analysis of patients operated on by two surgeons.

SETTING

University and large tertiary referral private practice.

PATIENTS

Seventy-four patients over a 10-year period, with bilateral or unilateral proximal occlusion of a single tube.

INTERVENTIONS

Hysteroscopic cannulation, resection anastomosis, or both.

MAIN OUTCOME MEASURES

Intrauterine and ectopic pregnancy rates, long-term tubal patency, and pathology of tubal segments.

RESULTS

In patients with normal distal tubes, intrauterine pregnancy rates were similar (12/21, 57% versus 12/24, 50%) and ectopic pregnancy rates were lower (0/21, 0% versus 7/24, 29.1%) in the cannulation group. One-year patency rates in nonpregnant patients was higher in the anastomosis group (12/15, 80% versus 3/8, 33%).

CONCLUSIONS

Hysteroscopic cannulation should be first choice in the management of proximal tubal obstructions in selected patients. It may be a treatment option for delayed occlusion after successful cannulation or resection anastomosis.