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Hum. Reprod. Advance Access originally published online on April 28, 2005
Human Reproduction 2005 20(8):2355-2358; doi:10.1093/humrep/dei046
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© The Author 2005. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions{at}oupjournals.org

Sutureless re-anastomosis by laparoscopy versus microsurgical re-anastomosis by laparotomy for sterilization reversal: a matched cohort study*

Maarten A.H.M. Wiegerinck1,4, Maryse Roukema2, Piet H. van Kessel2 and Ben W.J. Mol1,2,3

1 Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, 2 Department of Obstetrics and Gynaecology, TweeStedenziekenhuis, Tilburg and 3 Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands

4 To whom correspondence should be addressed at: Department of Obstetrics and Gynaecology, P.O.Box 7777, 5500 MB Veldhoven, The Netherlands. Email: m.wiegerink{at}mmc.nl

BACKGROUND: Sutureless re-anastomosis per laparoscopy is an alternative for microsurgical re-anastomosis by laparotomy in the treatment of sterilized women with renewed child wish. Our aim was to compare pregnancy rates after both surgical techniques. METHODS: We performed a retrospective cohort study in which consecutive women who underwent sutureless re-anastomosis per laparoscopy were compared to women who underwent microsurgical re-anastomosis by laparotomy. Both procedures were performed in neighbouring hospitals in Northern-Brabant, The Netherlands, and women were matched for age. The primary outcome was time to ongoing pregnancy. RESULTS: Overall, we included 41 women who had sutureless re-anastomosis by laparoscopy, and 41 age-matched women who underwent microsurgical re-anastomosis by laparotomy. The number of women who conceived was 20 (15 ongoing pregnancies) in the sutureless laparoscopic group versus 26 (24 ongoing pregnancies) in the laparotomic group, a difference due to a longer follow-up period in the laparotomic group. Time to ongoing pregnancy was comparable in both groups (P=0.46), with 3 year cumulative ongoing pregnancy rates of 45 and 52% respectively. After adjustment for other prognostic factors, the fecundity rate ratio was 0.97 (95% CI 0.26–3.6), indicating a similar performance of the two techniques. CONCLUSION: The simplified stitchless laparoscopic procedure for reversal of tubal sterilization with the use of a tubal splint, clip fixation of the muscularis and fibrin glue resulted in a promising pregnancy rate, which was similar to the pregnancy rate obtained with the microsurgical re-anastomosis per laparotomy.

Key words: laparoscopy/re-anastomosis/sterilization/sutureless

* Partly presented at the 19th Annual meeting of the ESHRE, 2003, Madrid, Spain.


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