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Hum. Reprod. Advance Access published online on April 28, 2005
Human Reproduction, 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@oupjournals.org
Received July 26, 2004
Revised March 9, 2005
Accepted April 4, 2005

Article

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

Maarten A.H.M. Wiegerinck 1*, Maryse Roukema 2, Piet H. van Kessel 2, and Ben W.J. Mol 3

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

* To whom correspondence should be addressed.
Maarten A.H.M. Wiegerinck, E-mail: m.wiegerink{at}mmc.nl


  Abstract

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.

Keywords: laparoscopy; re-anastomosis; sterilization; sutureless.

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


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