[The value of laparoscopic and laser-assisted techniques in reconstruction of distal fallopian tube pathology].
In an overall study population (3 different study designs) of n = 285 patients the role of laparoscopic resp. laser-assisted techniques was evaluated on the basis of the results of distal tubal reconstruction. An interventional comparison of a laparoscopic (n = 150) with a retrospective microsurgical (n = 135) group of patients with distal tubal pathology showed a significantly higher baby-take-home rate in the laparoscopically treated patients (38% vs. 22.2%, p < 0.05), but detailed critical analysis of indication revealed a certain selection effect in the laparoscopic group. A prospective study on laser (n = 100) and non-laser techniques for salpingostomy showed in no significant differences between the two groups, as results were concerned (delivery 35% in the laser, 44% in the non-laser cohort). In a prospective randomized subgroup laparoscopic fimbrial eversion with the laser was compared to suture eversion (n = 20). In both groups the reocclusion rate was of 20%. On may thus conclude, that the most important surgical approaches for treatment of a tuboperitoneal sterility: micro-surgery and endoscopy, resp. the various surgical techniques: laser and non-laser, should not be regarded as competing procedures, but as components of a multimodal strategy. The indication, however, must be critically viewed in every particular case. Of major importance being strict scientific evaluation criteria to prevent misinterpretations, e.g. based on indication-specific selection.
Wallwiener
D
D
Universitäts-Frauenklinik Heidelberg.
Maleika
A
A
Rimbach
S
S
Homann
G
G
Rabe
T
T
Gauwerky
J
J
Bastert
G
G
D000328:Adult; D005184:Fallopian Tube Diseases / Q000601:surgery*; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000601:surgery; D020706:Laparoscopes; D053685:Laser Therapy / Q000295:instrumentation*; D008866:Microsurgery / Q000295:instrumentation*; D011183:Postoperative Complications / Q000209:etiology; D011247:Pregnancy; D011446:Prospective Studies; D012189:Retrospective Studies; D013536:Suture Techniques / Q000295:instrumentation; D016896:Treatment Outcome