Role of laparoscopic salpingostomy in the treatment of hydrosalpinx.
OBJECTIVE
To determine pregnancy rates after laparoscopic salpingostomy in occlusive distal tubal disease. To evaluate the relative impact of various historical, physical, and operative factors on pregnancy outcome using a multivariate statistical analysis.


METHODS
Prospective cohort.


METHODS
University-affiliated tertiary care infertility clinic.


METHODS
One hundred thirty-nine infertile women with occlusive distal tube disease.


METHODS
Laparoscopic salpingostomy.


METHODS
The occurrence of intrauterine (IUP) and ectopic pregnancy (EP).


RESULTS
The overall IUP and EP rates were 24.5% and 16.5%, respectively. Analysis of historical variables, assessed independently, demonstrated a significantly higher IUP rate with a positive history of gonorrhea and a significantly higher EP rate with a positive history of pelvic inflammatory disease, lack of history of intrauterine device (IUD) usage, or the performance of a bilateral procedure. The logistic regression model to predict intrauterine pregnancy had an overall predictive value of 77.5% and included the following significant variables: secondary infertility, positive history of gonorrhea, and the operative finding of moderate periadnexal adhesions. The logistic regression model to predict ectopic pregnancy had an overall predictive value of 89.0% and included the following significant variables: previous ectopic pregnancy, negative history of IUD use, positive history of PID, a bilateral procedure, and perihepatic adhesions.


CONCLUSIONS
Operative laparoscopy may be effective for the correction of hydrosalpinges in selected patients. The probability of achieving an intrauterine or an ectopic pregnancy can be predicted based on combinations of significant variables.
Taylor
R C
RC
University of British Columbia, Vancouver, Canada.
Berkowitz
J
J
McComb
P F
PF
D000328:Adult; D015331:Cohort Studies; D005184:Fallopian Tube Diseases / Q000601:surgery*; D005260:Female; D006069:Gonorrhea / Q000150:complications; D006801:Humans; D007247:Infertility, Female / Q000209:etiology / Q000628:therapy; D007434:Intrauterine Devices / Q000009:adverse effects; D010535:Laparoscopy; D016015:Logistic Models; D000292:Pelvic Inflammatory Disease / Q000150:complications; D011247:Pregnancy; D011256:Pregnancy Outcome; D011271:Pregnancy, Ectopic / Q000453:epidemiology* / Q000209:etiology; D011446:Prospective Studies; D012489:Salpingostomy / Q000379:methods*; D016896:Treatment Outcome