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.