Differentiated approach to the use of the modern surgical technologies in patients with tubal infertility

Aim. To elaborate the differentiated approach to the surgical treatment of the patients with tubal and peritoneal infertility using the endoscopic and microsurgical methods and to evaluate its efficiency. Methods. 1840 female patients with infertility underwent complex clinical and laboratory examination, including endoscopy. 1257 patients underwent surgical treatment. Endo-video-surgical interventions were carried out in 1070 women, microsurgical techniques were applied in 187 patients. Results. The laparoscopic reconstructive plastic surgery was the most effective manipulation in patients with the disease of the distal part of the fallopian tubes and peritoneal adhesions. Treatment results were defined by the severity of distal part of the uterine tubes damage and severity of peritoneal adhesions in the pelvic cavity. The most favorable results of the treatment were noted after salpingo-ovariolysis (success rate 61.4%), by 2.3 times exceeding the pregnancy frequency after salpingoneostomy (26.9%; p <0.001) and by 1.6 times compared to fimbrioplasty (39.2%; p <0.001). In patients with proximal occlusion, results depended on the type of the tubular occlusion. In 69.7% patients with proximal occlusion due to synechiae, small polyps, foreign bodies, hysteroscopic interventions were an effective method of recanalization, allowing to restore the reproductive function in 40.2% patients. The microsurgical method demonstrated the 5.9 fold higher efficiency in patients with fibroid proximal occlusion of the uterine tubes compared to the laparoscopic methods (41.7% vs 7.1%). The microsurgical method was the most effective in patients with true fibrous proximal occlusion after the surgery on uterine tubes for tubular pregnancy and surgical sterilization. Conclusion. The differentiated approach to the surgical treatment of the patients with tubal infertility allowed to use the endo-video-surgical method in 85.1% of cases, improving the treatment’s results due to the decrease the surgical trauma and surgery duration, due to economic and cosmetic effect.

female infertility, tubal infertility, reproductive surgery, laparoscopy, microsurgery, hysteroscopy