Role of laparoscopic salpingostomy in the treatment of hydrosalpinx

Objective: To determine pregnancy rates after laparoscopic salpingostomy in occlusive distal tubal disease. To evaluate the relative impact of various historical, physical, and operative factors on pregnancy outcome using a m ultivariate statistical analysis. Design: Prospective cohort. Setting: University-affiliated tertiary care infertility clinic. Patient(s): One hundred thirty-nine infertile women with occlusive distal t ube disease. Intervention(s): Laparoscopic salpingostomy. Main Outcome Measure(s): The occurrence of intrauterine (IUP) and ectopic p regnancy (EP). Result(s): The overall TUP and EP rates were 24.5% and 16.5%: respectively Analysis of historical variables, assessed independently, demonstrated a si gnificantly higher IUP rate with a positive history of gonorrhea and a sign ificantly higher EP rate with a positive history of pelvic inflammatory dis ease, lack of history of intrauterine device (IUD) usage, or the performanc e of a bilateral procedure. The logistic regression model to predict intrau terine pregnancy had an overall predictive value of 77.5% and included the following significant variables: secondary infertility, positive history of gonorrhea, and the operative finding of moderate periadnexal adhesions. Th e logistic regression model to predict ectopic pregnancy had an overall pre dictive value of 89.0% and included the following significant variables: pr evious ectopic pregnancy, negative history of IUD use, positive history of PLD, a bilateral procedure, and perihepatic adhesions. Conclusion(s): Operative laparoscopy may be effective for the correction of hydrosalpinges in selected patients. The probability of achieving an intra uterine or an ectopic pregnancy can be predicted based on combinations of s ignificant variables. (C) 2001 by American Society for Reproductive Medicin e.