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At least 19 recordsLinked to original sources
PubMed1980

Reversal of Kroener fimbriectomy sterilization.

Sterilization by fimbriectomy has been thought to be irreversible. The present report describes the surgical approach and results in nine patients after microsurgical tubal reconstruction and indicates that repeated pregnancy is possible after fimbriectomy reversal. Preoperative radiographic studies were used to document cornual patency and to evaluate the length, width, and rugal pattern of the ampullary segment. A new ostium was created by transverse salpingostomy and a cuff-eversion technique by means of microsurgical methods. A tubal patency rate of 83% and an intrauterine pregnancy (IUP) rate of 44% was achieved. The mean interval from operation to conception was 6 months. There were no ectopic pregnancies. The ideal candidate for fimbriectomy reversal has tubal remnants 8 cm or longer, an ampullary width of 1 cm or greater, rugal patterns on x-ray film, and minimal peritubal adhesions. Successful reversal was associated with protrusions of the endosalpinx to form a neofimbria. The success of fimbriectomy sterilization probably depends more on complete ampullary occlusion than on absence of the infundibulum with fimbria. The role of the fimbria in ovum pickup is discussed. The IUP rate after microsurgical fimbriectomy reversal compares favorably with the IUP rate after macrosurgical end-to-end anastomosis and exceeds the reversibility rate of laparoscopic electrocoagulation sterilization.

Adult↗
PubMed2001

Pregnancy rates following fimbriectomy reversal via neosalpingostomy: a 10-year retrospective analysis.

OBJECTIVE: To establish parameters associated with successful fimbriectomy reversal and to estimate monthly fecundability and cumulative pregnancy rates through life-table analysis. DESIGN: Series report. SETTING: University-based infertility clinic. PATIENT(S): Forty-one women undergoing surgery for tubal sterilization reversal. INTERVENTION(S): Surgical fimbriectomy reversal. MAIN OUTCOME MEASURE(S): Time from sterilization to reversal, laparoscopy vs. laparotomy, uni- vs. bilateral fimbriectomy reversal, Bruhat vs. suture, tubal lengths, postsurgical hysterosalpingogram, ovulation induction, incidence of pregnancy and outcome, and life-table analysis to determine pregnancy rate. RESULT(S): The mean time from sterilization to reversal was 11.5 years. Of the 41 women who underwent fimbriectomy reversal, 6 (14.6%) conceived. Sixteen reversals were performed by laparotomy resulting in 4 (25%) pregnancies, whereas 25 were performed laparoscopically resulting in 2 (8%) pregnancies. Eight had unilateral salpingostomies and 33 bilateral, of which 1 of 8 (12.5%) and 5 of 33 (15.2%) conceived, respectively. Using the Bruhat technique, 1 of 11 (9%) conceived vs. 5 of 30 (16.7%) that underwent reversal using sutures. The mean postoperative tubal length for the 6 women who conceived was 8 cm vs. 6.7 cm in the 35 women who did not conceive. Postoperatively, 26 women received ovulation induction and 1 (3.8%) conceived whereas 5 (33.3%) conceptions occurred in 15 women who did not require ovulation induction. Using life-table analysis with 619 postsurgical cycles, the monthly fecundability was.0097. The cumulative conception rate after 5 years was 31.2%. CONCLUSION(S): Neosalpingostomy for the reversal of fimbriectomy sterilization represents a viable option for fertility restoration. The best candidates for this procedure are spontaneously ovulatory and have a tubal length of more than 7 cm.

Adult↗
PubMed1980

Experience in a series of fimbriectomies.

In a series of 247 consecutive sterilizations by fimbriectomy performed at the Denver General Hospital, a failure rate of 2.4% was found. The literature is reviewed, and these results are compared with results of other series. In several of the fimbriectomy series with more successful outcome, modifications of the technique originally described were used. The difficulties associated with the Kroener technique are discussed. The fimbriectomy failures were caused by either lack of resection of all of the fimbriae or the presence of tuboperitoneal fistulas, both congenital and acquired. Fimbriectomy should not be regarded as the method of choice for sterilization unless one can ensure adequate surgical exposure and complete removal of the fibria, including the fimbria ovarica.

Adult↗
PubMed1978

Failures following fimbriectomy: a further report.

In 1977 we reported on seven patients who presented with intrauterine pregnancy in spite of previous fimbriectomy; in a detailed morphologic study one tuboperitoneal fistula was documented in each of four patients. In the present study three more patients are reported with pregnancy following fimbriectomy, and another four tuboperitoneal fistulas are morphologically investigated and their possible etiology is discussed. In spite of a failure rate of almost 2.6%, the concept about the reliability of fimbriectomy need not necessarily be condemned. This concept can be judged only if information is available both about the total number of fistulas subsequent to a certain technique and about the number of those fistulas which contributed to pregnancy.

Fallopian Tubes↗
PubMed1981

Fertility following fimbriectomy and tubo-ovarian microsurgery in the rabbit.

It is generally believed that tubal fimbriae function as a highly specialized and indispensable component of the ovum pickup mechanism. The present study was undertaken to examine the feasibility of creating a functional tubo-ovarian relationship following fimbriectomy. Fourteen New Zealand White rabbits underwent unilateral microsurgical fimbriectomy followed by creation of a distal ampullary flap which was oversewn to the exposed ovarian cortex. Two weeks after surgery, the animals were inseminated and induced to ovulate with an intravenous injection of 100 IU of human chorionic gonadotropin. Thirteen of fourteen uterine horns on the control side and ten of fourteen on the operated side became pregnant. The ratios of ova ovulated to those which implanted were 73.2% on the control side and 37.8% on the operated side. Morphologic studies revealed a normal complement of ciliated and secretory cells lining the endosalpinx of the juxtaposed ampullary flap. The portion of ovarian cortex covered by the flap similarly exhibited no morphologic abnormalities. These findings indicate that fertility can be maintained in the absence of fimbriae and suggest a surgical technique for restoration of fertility following elective sterilization by fimbriectomy or following pathologically induced destruction of the fimbriae.

Animals↗
PubMed1995

A new selection criterion for fimbriectomy reversal.

OBJECTIVE: To assess a new criterion for selection of patients who request reversal of fimbriectomy sterilization. DESIGN: Prospective study. SETTING: Division of reproductive endocrinology and infertility in an academic center. PATIENTS: Eight patients undergoing reversal of fimbriectomy using microsurgical techniques. The prerequisite inclusion criterion was the presence of more than 50% ampulla as shown at hysterosalpingography. This is easily determined, because the isthmic length approximates one half the ampullary length. RESULTS: The cumulative intrauterine pregnancy rate was 50%. There were no ectopic pregnancies. CONCLUSION: Similar pregnancy rates for reversal of fimbriectomy have been reported based upon different absolute selection criteria (viz., tubal length of > or = 8 cm and ampullary width of > or = 1 cm). By contrast, our new selection criterion is based upon the more readily determined proportion of ampulla that is available for surgical neostomy.

Female↗
PubMed1977

Failures following fimbriectomy.

From 1970 through 1973, 388 bilateral fimbriectomies were performed. By the end of 1974, seven pregnancies had occurred, and in four of these patients a resterilization laparotomy was performed. All four cases showed a unilateral tuboperitoneal fistula. These fistulas were examined and compared morphologically with congenital tuboperitoneal fistulas. This proved that all four fistulas were acquired and that they were probably caused by the catgut ligatures used for ampullary ligation. The rather frequent occurrence of hydrosalpinx after fimbriectomy is mentioned. Finally, it seems of questionable advantage to resect the infundibulum as part of a fimbriectomy using the three-ligature technique.

Fallopian Tubes↗
PubMed1981

Ovum capture and fertility following microsurgical fimbriectomy in the rabbit.

Microsurgical fimbriectomy with removal of the fimbria ovarica was performed on one side in 19 rabbits. The other tube was left intact as a control. In 10 animals the new ostium was left free, some distance from the ovary. In the remainder, the ostium was fixed to the ovarian capsule. Three animals with a fixed ostium developed mild hydrosalpinx even though the neostomy was patent. Of the remaining 16 rabbits, 15 conceived and became pregnant in both uterine horns. There was no significant difference between nidation index on the two sides. It is concluded that intact fimbriae with a fimbria ovarica are not essential for normal ovum capture. It is therefore suggested that methods for clinical salpingostomy may require re-evaluation.

Animals↗
PubMed1981

Function and structure of the rabbit oviduct following fimbriectomy. I. Distal ampullary salpingostomy.

The fimbria has long been considered an indispensable portion of the fallopian tube. To test this hypothesis, the fimbria and up to one-half of the adjoining ampulla of the left oviduct were resected by microsurgery in 13 New Zealand White does. The remaining distal ampulla was subjected to a cuff salpingostomy. Following a convalescence of 4 to 8 weeks and induced ovulation, 6 of the 11 resected oviducts apprehended ova and 29% of the total number ovulated ipsilaterally, whereas the right control oviducts retrieved 77% of the corresponding ova. Direct observation in vivo showed that the ova adhered to the neofimbria and that subsequent transport across the everted, hypertrophied ampullary mucosal folds into the tubal lumen took place readily. Scanning electron microscopy of the "neofimbria" and adjoining distal ampulla demonstrated populations of ciliated and secretory cells that were similar to those of the contralateral intact fimbria. This information challenges the concept of fimbrial indispensability and depicts the fimbriated ostium of a distal ampullary cuff salpingostomy as having an adequate function, albeit less efficient than normal

Animals↗
PubMed1981

Function and structure of the rabbit oviduct following fimbriectomy. II. Proximal ampullary salpingostomy.

Experiments were conducted in nine New Zealand White rabbits to determine the functional capacity of that part of the oviduct consisting of only the isthmus and proximal ampulla. The left fimbria and at least one-half of the adjoining ampulla were excised microsurgically and the remaining portion of the proximal ampulla was subjected to a cuff salpingostomy. Following a convalescence of 4 to 8 weeks and gonadotropin-induced ovulation, direct observations in vivo showed tht the modified oviduct was ineffective in transporting surrogate cumulus masses into the tubal lumen. Those surrogates that were accepted were in some cases regurgitated by contractions of the residual proximal ampulla. A subsequent in vitro search for ova proved that the modified oviducts were unsuccessful in retrieving ipsilaterally ovulated ova, whereas the contralateral control oviducts apprehended an average of 72% of those available. Scanning electron microscopy showed the everted mucosa of the proximal ampulla to be less richly endowed with cilia than that of the normal fimbria. This ovum capture appeared to be prevented by deficiencies in both the ciliary mechanism of the neofimbria and the ability of the remaining ampulla to retain the egg. This evidence indicates that the proximal ampulla is unsuitable for reconstruction of a functional fallopian tube.

Animals↗
PubMed2005

Effects of three different sterilization methods on utero-ovarian Doppler blood flow and serum levels of ovarian hormones.

OBJECTIVE: The aim of the study was to assess pre-operative and post-operative serum levels of ovarian hormones and changes in utero-ovarian arterial blood flow by Doppler ultrasonography in women in whom one of three different sterilization methods was applied. STUDY DESIGN: The Pomeroy method of tubal ligation, fimbriectomy, or laparoscopic bipolar coagulation were applied in 42 patients. Serum levels of sex hormones were checked, and utero-ovarian arterial Doppler measurements were performed pre-operatively and post-operatively. The presence or absence of dysmenorrhea was noted before and after the operations. RESULTS: We detected a significant increase in the average uterine arterial resistivity index (RI) and both ovarian arterial pulsatility index (PI) values in the Pomeroy method group (p<0.05). There was a significant increase in dysmenorrhea complaints in the total number of patients (p<0.05), particularly in the fimbriectomy group. CONCLUSION: The significant increase in uterine arterial Doppler measurements with the Pomeroy method may be due to the removal of a larger tubal segment. Even though the increase is not statistically significant, fimbriectomy should not be applied in young women, because it may increase dysmenorrhea and the procedure is not reversible.

Adult↗