Tubocornual Anastomosis Research Articles

Restoring tubal patency with laparoscopic tubocornual anastomosis

ObjectiveTo assess the technical feasibility of laparoscopic tubocornual anastomosis (TCA) at restoring tubal patency in patients with proximal tubal occlusions. Materials and methodsA retrospective analysis of fourteen females with identified proximal tubal occlusions seeking to restore their tubal patency in a university-affiliated tertiary hospital between 2011 and 2018. Tubal patency within one year after the surgery was evaluated. ResultsThe patients had a mean age of 34.0 ± 3.6 years old, median parity of 1 child, and mean BMI of 23.0 ± 5.2 kg/m2. Of the fourteen patients, two (14.3%) received bilateral TCA, eight (57.1%) received only unilateral TCA, and four (28.6%) received TCA on one side and tubal anastomosis on the other. The operative time was 126.4 ± 37.9min for unilateral procedure and 201.0 ± 1.4 min for bilateral anastomoses. Postoperative hysterosalpingogram (HSG) demonstrated a patency rate of 64.2% at the TCA sites. Two ectopic pregnancies were reported thereafter. ConclusionThis preliminary series demonstrates that laparoscopic TCA is technically feasible and provides promising results for patients with proximal tubal occlusions hoping to restore their tubal function in order to conceive naturally. A larger prospective series is mandatory to establish its significance and application in clinical practices. Notably, infertile patients without surgically correctable factors are not suitable for this procedure.

Is there still a role for reconstructive microsurgery in tubal infertility?

To review the current role of tubal reconstructive surgery in the era of assisted reproductive techniques (ARTs). After tubal reconstructive surgery, couples may have unlimited attempts to conceive naturally. Operative risks are low; the risk for ectopic pregnancy after surgery is 4-10%. ART is associated with a number of potential complications: severe ovarian hyperstimulation syndrome (0.25-2%), multiple pregnancies (up to 25%), a higher rate of major malformations and stillbirths, and ectopic pregnancy (1-13%). Birth rates following ART differ between 19 and 35%, depending on different laws governing the fertilization of a limited number of oocytes and the number of embryos transferred. Resterilization is a main indication for microsurgery with resulting pregnancy rates up to 84%. Salpingostomy and dense adhesiolysis have the lowest success rates (term pregnancy rates: 3-65%). Proximal tubal obstructions can be successfully treated by tubocornual anastomosis. Hydrosalpinges should be removed prior to in-vitro fertilization if they cannot be reconstructed. ART is recommended for patients older than 37-38 years, for women with severe tubal pathology, after repeated ectopic pregnancies, and in case of male infertility. Tubal reconstructive surgery still plays a role in infertility treatment. ART has not replaced microsurgery routinely as first-line treatment for tubal infertility.

Intrapartum posterior uterine wall rupture in lower segment cesarean section scarred uterus

Intrapartum uterine rupture is a well-documented complication of labor that fortunately is a rare event. The majority of these cases arise in women with scarred uteri secondary to some event such as previous cesarean section myomectomy deep cornual resection metroplasty tubo-cornual anastomosis iatrogenic or traumatic uterine rupture. Vaginal birth after cesarean (VBAC) is now a safe and well-accepted procedure of conduct in women with one previous lower segment cesarean section (LSCS). Uterine rupture in such women commonly involves the anteriorly placed scar. Posterior rupture in women in whom VBAC was attempted has also been reported although only twice in the literature. Here we report a similar case of posterior uterine rupture in a woman in labor with a previous LSCS to add further data to this rare and isolated complication. (excerpt)

Microsurgical resection of nonocclusive salpingitis isthmica nodosa is beneficial

Objective To determine the effect of microsurgical resection and tubocornual anastomosis (TCA) of nonocclusive salpingitis isthmica nodosa (SIN) on fertility and risk for ectopic pregnancy (EP). Design Prospective cohort. Setting University–affiliated tertiary fertility clinic. Patient(s) Infertile women with hysterosalpingography evidence of SIN in patent fallopian tubes. Intervention(s) Microsurgical resection and TCA for nonocclusive SIN. Main outcome measure(s) Occurrence of IUP and EP after TCA; comparison of duration of infertility preceding TCA with time to intrauterine pregnancy (IUP) after TCA; and comparison of numbers of women who conceived an EP before and after TCA. Result(s) Twelve (46%) of the women had IUPs with a mean time to pregnancy of 10.5 months, which is significantly shorter than the preceding period of infertility. Three women experienced EPs after TCA, which is reduced compared with the number of women with an EP preceding the TCA. Conclusion(s) The significant decrease in time to conceive an IUP after surgery as compared with the duration of infertility before surgery and the apparent reduction in risk for EP after surgery demonstrate the benefit of TCA for resection of nonocclusive SIN.

Tubal surgery in the era of assisted reproductive technology: clinical options.

We reviewed the place of tubal surgery in the era of assisted reproductive technology. Reversal of tubal ligation is one of the main indications for tubal microsurgery. Adhesiolysis has the best results if the adhesion is the only factor responsible for infertility. There are no differences between adhesiolysis by laparoscopy or by laparotomy, and so laparoscopy must be preferred. Proximal tubal obstructions can be successfully treated by microsurgical tubocornual anastomosis. As far as distal tubal lesions are concerned, success rates depend strictly on the pre-existing tubal disease in distal tubal lesions and tubal surgery frequently fails; in-vitro fertilization (IVF) must therefore be considered in such circumstances. In conclusion, we think that IVF and tubal surgery must be considered to be complementary rather than competitive procedures. Adequate selection of patients is crucial to find the best therapeutic approach.

Surgery: Microsurgery and in-vitro fertilization and embryo transfer for infertility resulting from pathological proximal tubal blockage

The aim of this study was to evaluate the prognosis for the patients after the treatment of infertility resulting from proximal tubal blockage using microsurgical tubocornual anastomosis and in-vitro fertilization (IVF) and embryo transfer complementarily. A total of 59 microsurgical operations (1986-1992) for infertility resulting from pathological proximal tubal lesions were analysed. The cumulative live birth rate was 52% for tubocornual anastomosis, 58% for bilateral operations and 28% for two-site operations. In all, 35 singleton babies were born. Of the 32 operated patients who did not deliver within 2 years of surgery, 21 were treated by 66 IVF cycles; 12 babies were born. The live birth rate was 18% per cycle and 57% per patient. Combining both treatment methods the cumulative live birth rate was improved up to 69% in the group of tubocornual anastomoses, up to 75% in the group of bilateral operations, and up to 57% in the group of two-site operations. Complementary use of microsurgery and IVF and embryo transfer improves the prognosis for selected infertile patients with pathological proximal tubal blockage. In the absence of pregnancy, IVF and embryo transfer should be commenced 1 year after surgery.

Term pregnancy after fallopian tube transposition

A 28-year-old woman suffered from pelvic pain and secondary infertility. She previously had right salpingo-oophorectomy because of ruptured right cornual EP. She was found to have a normal appearing left fallopian tube that entered into a noncommunicating residual horn of the uterus. Microsurgical transposition of the left tube and tubouterine implantation was performed successfully. For cases in which tubocornual anastomosis of the transposed tube is impossible because of previous cornual resection, our technique remains an option.

Reproductive outcome after unilateral tubocornual anastomosis and contralateral salpingostomy by microsurgery

A unilateral tubocornual anastomosis and a contralateral salpingostomy for unilateral proximal and contralateral distal occlusive disease yield similar fertility as does pure tubocornual anastomosis for proximal occlusive disease. Ascending inflammation is postulated as the mechanism for tubal occlusion, with distal sparing from disease if the initial insult results in initial occlusion of the proximal portion of the oviduct.

Tubocornual anastomosis: surgical considerations and coexistent infertility factors in determining the prognosis

To assess factors that may alter the pregnancy rate in women undergoing tubocornual anastomosis, the cases of 42 women were studied. Because a combination of surgical procedures was performed, the operative side deemed to be the best side was distinguished from the other side. The overall cumulative normal pregnancy rate was 56.0% after 2 years. Deep resection of the intramural tube and cases with technical difficulty had a reduced pregnancy rate. Neither the cornual pathology nor the presence of adnexal adhesions adversely affected the pregnancy rate. Associated infertility factors reduced the chances of conceiving. These factors should give a reliable prognosis to aid in the direction of postoperative management, particularly with regard to in vitro fertilization.

Microsurgical tubocornual anastomosis for occlusive cornual disease: Reproducible results without the need for tubouterine implantation

International Journal of Gynecology & ObstetricsVolume 25, Issue 5 p. 421-421 Citations from the literature fertility and sterility Microsurgical tubocornual anastomosis for occlusive cornual disease: Reproducible results without the need for tubouterine implantation P McComb, P McCombSearch for more papers by this author P McComb, P McCombSearch for more papers by this author First published: October 1987 https://doi.org/10.1016/0020-7292(87)90359-6AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume25, Issue5October 1987Pages 421-421 RelatedInformation

Microsurgical Tubocornual Anastomosis for Occlusive Cornual Disease

Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada Fertil. Steril. 46: 571, 1986

Microsurgical tubocornual anastomosis for occlusive cornual disease: reproducible results without the need for tubouterine implantation

Microsurgical tubocornual anastomosis (TCA) and tubouterine implantation are the two primary operations used to treat proximal tubal occlusion (PTO). Tubouterine implantation usually has been reserved for cases of PTO in which the occlusion spans the entire intramural tubal segment. Yet TCA has proven to be more likely to lead to successful pregnancy than tubouterine implantation. In this series, all PTO was treated by TCA. The article compares the reproducibility of results of TCA by two different operators and establishes the usefulness of TCA in all cases of PTO without resort to tubouterine implantation. Fifteen of 26 women achieved viable intrauterine pregnancies, a rate virtually identical to that published earlier by Gomel. Microsurgical TCA can be used to the exclusion of tubouterine implantation to achieve higher pregnancy rates, despite complete intramural occlusion.

Pregnancy following tubocornual anastomosis

We have reviewed the pregnancy rate and outcome of 25 patients who underwent tubocornual anastomosis for correction of proximal tubal occlusion at Yale-New Haven Hospital between 1977 and 1981. Tubal occlusion was the result of previous tubal sterilization in 17 patients (11 laparoscopic electrocautery and 6 tubal ligation) and previous tubal infection in 8. Fourteen of the patients conceived (56%). Viable pregnancy was achieved in nine patients (36%) and tubal pregnancy in three (12%). No significant difference in pregnancy rates was found between patients with diseased cornua and those previously sterilized by either electrocautery or tubal ligation. Tubal length of greater than or equal to 4 cm following corrective surgery as compared with less than or equal to 4 cm did not influence pregnancy rates. The patients with the shorter oviducts had a higher rate of early pregnancy wastage. All three tubal pregnancies occurred in patients with reoccluded fallopian tubes as demonstrated by a hysterosalpingogram. We conclude that tubocornual anastomosis still remains the treatment of choice for patients with proximal tubal obstruction.

Surgical management of tubal obstruction at the uterotubal junction

"The surgeon who works in the sterile tube will get the best results from the operation that produces at least one good tube next to one good ovary, with the minimum of surgical trauma, and the minimal number of stitches." This comment by Grant in 1971 also holds true today as infertility surgeons strive through new techniques and instrumentation to give renewed reproductive potential to all varieties of diseased and occluded fallopian tubes. It is our observation (certainly shared by others) from personal experience and from the literature that, assuming all other fertility factors are functionally normal, there are only three conditions that need to be met by reconstructed tubes to offer the possibility of pregnancy: (1) the final length of the tube must be sufficient to reach from the uterus to the site of ovum pickup, whether the ovary or the cul-de-sac; (2) there must be sufficient mucosal amount and function to produce the oviductal secretions that regulate and support the sperm, ovum, and conceptus; and (3) there must be sufficient tubal function to delay morula or blastocyst transport until the endometrium is prepared for implantation. It is apparent from this review that all varieties of UTJ reconstructive operations have proven their potential to endow the postoperative tube with the above requirements for pregnancy, despite the fact that many result in the removal or bypass of large segments of proximal and mid-segment tubal tissue thought to be important in the normal reproductive process. Therefore, the hesitancy and lack of enthusiasm that once existed to tackle cornual and isthmic occlusions should no longer be as widespread. There will always be a place for whatever favorite procedure works best in one's hands, because the technique of the surgeon is probably more important than the type of UTJ procedure, but it is our opinion that microsurgical tubocornual anastomosis should be one's primary approach to correcting a UTJ obstruction. Microanastomosis has been consistently more successful than implantation techniques, is associated with fewer postoperative complications, and is designed to conserve maximum amounts of normal cornual and tubal tissue. However, given the circumstances of complete intramural occlusion or surgeon preference, any of the described uterotubal implantation operations can be confidentiality utilized as a primary or secondary approach to surgical reconstruction of UTJ obstructions.

MICROSURGICAL TUBOCORNUAL ANASTOMOSIS FOR REVERSAL OF STERILISATION

11 of 16 patients had intrauterine pregnancies after microsurgical tubocornual anastomosis for reversal of sterilisation. This procedure has several important advantages over tubal reimplantation and may be of benefit in the treatment of infertile women with inflammatory blockage of the isthmus of the fallopian tube.