Reconstructive Surgery of Hydrosalpinx with and without the Carbon Dioxide Laser

Abstract

In the surgical correction of hydrosalpinx, the CO2 laser offers some advantages, including precision of application, minimal bleeding, rapid healing, and minimal scar formation. It remains to be seen whether the pregnancy rate in “laser patients” is superior to that in patients who have had other kinds of surgery. The purpose of the present investigation was to compare the results of salpingostomy performed by three different methods: CO2 laser, micro-diathermy needle, and conventional surgery. The study was divided into two parts. In part 1, 45 women (20–36 years of age) with hydrosalpinx were studied. In order to ensure homogeneity in patient groups, only those women with complete bilateral terminal tube occlusions were included. Preoperative infertility investigations included semen analysis, basal body temperature measurement, postcoital test, hysterosalpingographic examination, timed endome-trial biopsy, and serum progesterone determination. The patients were then randomly assigned to undergo salpingostomy by CO2 laser (23 patients) or by microdiathermy needle (22 patients). No significant difference was found in the degree of tubal disease between the laser group (5.3 ± 0.7) and the nonlaser group (4.7 ± 0.3). When the degree of tubal disease was compared between patients who conceived and those who did not, no significant difference was found in either the laser or the nonlaser group (Table 1). When the data from the laser and the nonlaser group were combined, there was a significant difference in the degree of tubal disease between patients who conceived and those who did not (Table 1). The outcome of pregnancy in the two groups is shown in Table 2. A significantly shorter surgery-conception interval was found in the laser group than in the nonlaser group (Table 2). Part 2 of the investigation involved a retrospective study of 45 women (20–37 years of age) with bilateral hydrosalpinx. The inclusion and exclusion criteria were similar to those of part 1. Salpingostomy in this group of patients was done conventionally with cold instruments (scissors). The mucosal flap was everted with 6–0 Vicryl sutures.