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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

Postal Subscription Code 80-967

2018 Impact Factor: 1.847

Front Med    2011, Vol. 5 Issue (3) : 310-314     DOI: 10.1007/s11684-011-0152-8
RESEARCH ARTICLE |
Fertility outcome analysis after modified laparoscopic microsurgical tubal anastomosis
Jihui Ai, Pei Zhang, Lei Jin, Yufeng Li, Jing Yue, Ding Ma(), Hanwang Zhang()
Department of Gynecology & Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
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Abstract  

Modified laparoscopic microsurgical tubal anastomosis is an alternative for microsurgical anastomosis via laparotomy to reverse sterilization in women with renewed child wish. The current study aims to evaluate the fertility outcome after modified laparoscopic microsurgical tubal anastomosis. A retrospective study was performed. Fifty-eight women who underwent modified laparoscopic microsurgical tubal anastomosis were monitored to investigate the fertility outcome and characteristics of this new technology. Of the 58 patients, the cumulative pregnancy rate (PR) in the 42 patients with follow-up data was 23.8% (10/42), 57.1% (24/42), 66.7% (28/42), and 73.8% (31/42) within 6, 12, 24, and 36 months after surgery, respectively. The intrauterine PR was 69.0% (29/42). Two patients (4.8%) had ectopic pregnancies that occurred within 24 months of surgery; three cases ended in spontaneous abortion. The delivery rate was 83.9% (26/31). The length of operating time was 1.2±0.3 h, with a range of 1.0–2.5 h (60–145 min), and the mean time was approximately 75 min. The blood loss was relatively small, between 10 and 50 ml with an average amount of 22 ml. Thus, the modified laparoscopic tubal anastomosis is a highly successful procedure and a viable alternative to open abdominal microsurgical approaches. Compared with the traditional laparoscopic tubal sterilization reversal, this modified approach has three advantages: (1) less invasive approach via a trocar reduction; (2) remodeling of tube is better performing tied together after 3–4 sutures; and (3) faster operating time.

Keywords modified laparoscopy      tubal anastomosis      microsurgery     
Corresponding Authors: Ma Ding,Email:dma@tjh.tjmu.edu.cn; Zhang Hanwang,Email:hwzhang605@126.com   
Issue Date: 05 September 2011
URL:  
http://academic.hep.com.cn/fmd/EN/10.1007/s11684-011-0152-8     OR     http://academic.hep.com.cn/fmd/EN/Y2011/V5/I3/310
Study periodMarch 2000 and March 2010
No. of cases58
Ageβ(year)33.23±β4.12 (27-44)
Interval from sterilization8.15
to operation (year)
Tab.1  Clinical characteristics of the patients
Fig.1  Trocar site diagram. (A) The previous laparoscopy tubal anastomosis: one 5-mm trocar was placed at the left Lee-yellow, and two were positioned at areas of the right McBurney point and 3 cm above the pubic symphysis. (B) The modified laparoscopy tubal anastomosis: one puncture point was reduced (the left Lee-yellow) based on the previous. One 5-mm trocar was placed at the fold line of the left abdominis rectus outer edge, and another on the intersection of the abdominal wall fold line and white line.
Fig.2  Schematic diagram of the wall and serosa suture. (A) The previous laparoscopy tubal anastomosis: the suture line was tightened after the slipknot is done. (B) The modified laparoscopy tubal anastomosis: the suture line was tightened one after another after all the knots had been completed.
No. of operations58
No. of follow-up patientsa42b
Overall pregnancy rate (%)73.8%β(31/42)
Intrauterine pregnancy (%)c69.0%β(29/42)
Spontaneous abortion (%)7.14%β(3/42)
Ectopic pregnancy (%)4.8%β(2/42)
Delivery (%)83.9%β(26/31)
The pregnancy rate related to the time after operation
6 months23.8%β(10/42)
12 months57.1%β(24/42)
24 months66.7%β(28/42)
36 months73.8%β(31/42)
Tab.2  Pregnancy outcome of the modified laparoscopic microsurgical tubal anastomosis
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