title: Laparoscopic surgery for distal tubal occlusions: lessons learned from a historical series of 434 cases.
abstract: OBJECTIVE
  To evaluate the success rate of laparoscopic neosalpingostomy and the factors affecting the results in terms of intrauterine pregnancy (IUP), delivery (DEL), and ectopic pregnancy (EP).
  
  
  METHODS
  Retrospective analysis of prospectively recorded data.
  
  
  METHODS
  Private practice.
  
  
  METHODS
  A total of 434 consecutive infertile patients from 21 to 42 years old with a follow-up of more than 10 years.
  
  
  METHODS
  Laparoscopic neosalpingostomy.
  
  
  METHODS
  Intrauterine pregnancy, delivery, and EP rates obtained without requiring IVF. Statistical analysis includes univariate and multivariate analysis and crude and actuarial success rates.
  
  
  RESULTS
  Just over one-quarter (28.8%) of the patients presented an IUP, 24.4% delivered, and 9% presented with an EP. The 5-year actuarial rate of delivery was 37%. This rate was largely dependent on the tubal stage (stage 1: 53.1%; stage 2: 43.1%; stage 3: 24.0%; stage 4: 23.1%). Forty-three percent of the expected IUPs started in the first year, and 75% started in the first two years. Multivariate analysis found some poor-prognosis patterns for tubal stage 3 (odds ratio [OR] 0.24), tubal stage 4 (OR 0.28), repeated neosalpingostomy (OR 0.168), previous EP (OR 0.202), severe adhesion stage (OR 0.211), and positive chlamydial serology (OR 0.515). Eversion with sutures provides nonsignificantly better results (OR 1.63) compared with eversion with coagulation.
  
  
  CONCLUSIONS
  Neosalpingostomy must not be proposed in selected cases according to the tubal stage, adhesion stage, and chlamydial serology. When neosalpingostomy is performed, fimbrial eversion with sutures provides slightly better results.
authors.affiliation: Institut Robert B. Greenblatt, Bordeaux, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Audebert
authors.affiliation: Department of Obstetrics, Gynecology and Reproduction, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France. Electronic address: jlpouly@chu-clermontferrand.fr.
authors.forename: Jean Luc
authors.initials: JL
authors.lastname: Pouly
authors.affiliation: Centre de Fécondation in Vitro, Polyclinique Jean Villar, Bruges, France.
authors.forename: Béatrice
authors.initials: B
authors.lastname: Bonifacie
authors.affiliation: Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire de Bichat, Paris, France.
authors.forename: Chadi
authors.initials: C
authors.lastname: Yazbeck
mesh_terms: D000328:Adult; D005184:Fallopian Tube Diseases / Q000601:surgery*; D005187:Fallopian Tubes / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D050498:Live Birth; D015999:Multivariate Analysis; D016017:Odds Ratio; D011247:Pregnancy; D018873:Pregnancy Rate; D011271:Pregnancy, Ectopic / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D012489:Salpingostomy / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Neosalpingostomy; laparoscopic surgery