DEVELOPMENT OF ENDOSALPINGOBLASTOSIS AND TUBOPERITONEAL FISTULAS FOLLOWING TUBAL-STERILIZATION - RELATION WITH UTERINE ADENOMYOSIS

A total of 25 consecutive patients who had undergone a tubal steriliza tion and who were referred for a hysterectomy, were examined by a pero perative methylene blue test of the tubal stumps, and extensive micros copic examination of the uterine wall, cornua and tubal stumps. Eighte en patients had been sterilized by electrocoagulation and 7 by mechani cal methods (clips or rings). Tubo- or uteroperitoneal fistulas and en dosalpingoblastosis were only observed in the group of patients steril ized by electrocoagulation. The development of tubo- or uteroperitonea l fistulas was correlated with the presence of endosalpingoblastosis a nd of uterine adenomyosis (P = 0.002 and P = 0.038, respectively). All patients with bilateral fistulas had bilateral endosalpingoblastosis and the only patient with a unilateral fistula had endosalpingoblastos is on the same side. The development of endosalpingoblastosis in patie nts sterilized by electrocoagulation was correlated with the presence of uterine adenomyosis (P = 0.008). In the same group of patients, a c orrelation between the length of the proximal tubal stump and the deve lopment of utero- or tuboperitoneal fistulas was observed (Wilcoxon te st, P = 0.033). Two patients developed an ectopic pregnancy following sterilization. Both patients were sterilized by electrocoagulation, an d had endosalpingoblastosis and bilateral fistulas. Our results sugges t that the presence of uterine adenomyosis might predispose to the dev elopment of endosalpingoblastosis when performing tubal electrocoagula tion close to the uterine cornum. We therefore suggest that when perfo rming tubal coagulation, the intact proximal stump should be at least 2 cm.