LAPAROSCOPIC-ASSISTED TUBAL ANASTOMOSIS

Study Objective. To determine the length of procedure, length of hospi tal stay, complications, and postoperative pregnancy rates of traditio nal tubal anastomosis (TA) and laparoscopic-assisted TA (LATA). Design . A comparison of 8 women undergoing LATA with 11 patients operated on by the same surgeon during a similar time period who were not candida tes for, or did not desire, a laparoscopic approach. Setting. Academic practice tertiary care setting. Patients. Women requesting reversal o f tubal ligation. Interventions. Tubal anastomosis by laparoscopy or l aparotomy. Measurements and Main Results. Patients undergoing the two procedures did not differ by age or parity, although those selected fo r LATA had a lower body mass index (23.2 +/- 1.4 vs 30.8 +/- 2.0 kg/m( 2), p = 0.01). Although the LATA took longer (251 +/- 14 vs 194 +/- 10 min, p = 0.004), hospital stay was significantly shorter than for tra ditional TA (1.8 +/- 0.3 vs 3.0 +/- 0.1 days, p = 0.004). Of the eight LATAs, six were completed and two were converted to laparotomy. For a ll patients with follow-up, clinical pregnancy rates were 43% and 29% (NS) for TA and LATA, respectively, with 100% of the former and 80% (N S) of the latter group who did not conceive having at least one patent tube on hysterosalpingogram. Conclusions. Laparoscopic-assisted TA is a possible alternative to the traditional TA performed by laparotomy. Ideal candidates for LATA appear to be women without obesity and with proximal tubal segments of 3 cm or greater. Larger studies with longe r follow-up will define appropriate candidates and identify long-term results.