HYSTEROSCOPIC CANNULATION FOR PROXIMAL TUBAL OBSTRUCTION - A CHANGE FOR THE BETTER

Objective: To compare overall the results of hysteroscopic tubal cannu lations 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 prac tice. Patients: Seventy-four patients over a 10-year period, with bila teral or unilateral proximal occlusion of a single tube. Interventions : Hysteroscopic cannulation, resection anastomosis, or both. Main Outc ome Measures: Intrauterine and ectopic pregnancy rates, long-term tuba l 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 rat es in nonpregnant patients was higher in the anastomosis group (12/15, 80% versus 3/8, 33%). Conclusions: Hysteroscopic cannulation should b e first choice in the management of proximal tubal obstructions in sel ected patients. It may be a treatment option for delayed occlusion aft er successful cannulation or resection anastomosis.