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Evidence summaries

Techniques for Pelvic Surgery in Subfertility

There is insufficient evidence for conclusion concerning the relative advantages or disadvantages of the different surgical techniques used for the treatment of tubal infertility. Level of evidence: "D"

A Cochrane review [Abstract] 1 included 7 studies. There was no evidence for or against the use of a CO2 laser compared with standard techniques for adhesiolysis (OR for pregnancy 1.07, 95% CI 0.40 to 2.87) or salpingostomy (OR for pregnancy 1.38, 95% CI 0.47 to 4.05) from two RCTs. One RCT randomised women for salpingostomatolysis by laparotomy and laparoscopy using the classic approach or the one suture technique. There was no evidence of benefit or disadvantage when laparoscopy was compared to laparotomy. The OR for bilateral tubal patency was 1.32 (95% CI 0.55 to 3.22) and unilateral tubal patency OR was 0.82 (95% CI 0.29 to 2.29). There was no evidence of benefit or disadvantage from two RCTs assessing the use of a prosthesis at salpingostomy compared with non-use (combined odds of pregnancy (term) in group using the prosthesis as compared to the control (OR for pregnancy at term 1.17, 95% CI 0.47 to 2.93). There was no evidence of benefit or disadvantage difference in one RCT comparing Cuff versus Bruhat technique for salpingostomy. One RCT compared two methods of salpingostomy (OR for pregnancy rate [intrauterine] 1.02, 95% CI 0.22 to 4.61). One RCT showed no evidence of benefit or disadvantage for the use of thermocoagulation or electrocoagulation at adhesiolysis; odds for pregnancy rate between the two groups OR 0.87 (95% CI 0.51 to 1.46).

References

  • Ahmad G, Watson A, Vandekerckhove P, Lilford R. Techniques for pelvic surgery in subfertility. Cochrane Database Syst Rev. 2006;(2):CD000221.

Primary/Secondary Keywords