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Hydrosalpinx, the blockage of fallopian tubes, can result from pelvic inflammatory disease. Hydrosalpinx is a cause of infertility and negatively impacts in vitro fertilization. To better understand the pathobiology of hydrosalpinx, we compared the proteome of lavages from disease vs. healthy fallopian tubes. Results indicate a disruption of redox homeostasis and activation of the complement system, immune cell infiltration, and phagocytosis; pathways that may drive tubal injury. To our surprise among the most prominent proteins with hydrosalpinx was mesothelin (MSLN), which until now has only been associated with epithelial malignancies. Analogous to mesothelioma and ovarian carcinoma, a significant increase of MSLN was detected in plasma from patients with hydrosalpinx. This finding suggests MSLN may provide clinical diagnosis in lieu of the current approaches that require invasive imaging. Importantly, these findings implicate MSLN in a benign disease, indicating that the activation and role of MSLN is not restricted to cancer.

Background: Uretero-fallopian fistula (UFF) is a very rare surgery complication which usually happens after surgeries of fallopian tube or ureter. There has been no report of interventional operations of fallopian tube causing UFF., Case Presentation: A 41-year-old female received fallopian tube embolization for birth control. After that she noticed "clear vaginal discharge". She neglected that symptom for 7 years, until a sudden onset of abdominal pain brought her to the ER. Retrograde ureterogram confirmed UFF and revealed severe hydronephrosis of the left kidney. She received left nephrectomy afterwards and recovered well, with no urine leakage from her vagina., Conclusion: UFF could be caused by interventional operations of fallopian tube, and could lead to severe consequences. The application of fallopian tube embolization should be carefully controlled.

Objective: To assess the objectivity and accuracy of a new system that predicts the pregnancy outcomes in patients with tubal pregnancy after laparoscopic salpingostomy., Study Design: 480 tubal pregnancy patients were retrospectively stratified as mild, moderate, or severe group according to the new tubal classification system in which pelvic adhesions, tubal morphology, structure, and patency were included. The follow-up was performed for 24 months to determine spontaneous pregnancy outcomes., Results: The tubal classification was significantly associated with intrauterine pregnancy rates (mild 70.9% vs. moderate 66.0% vs. severe 41.8%, P=0.001) and recurrent ectopic pregnancy rates (mild 2.8% vs. moderate 4.2% vs. severe 10.9%, P=0.047). The 24-month cumulative rate of intrauterine pregnancy was 73.5% in the mild group, 68.5% in the moderate group, and 45.8% in the severe group (P=0.002). The 24-month cumulative repeat ectopic pregnancy rate was 6.6% in the mild group, 9.1% in the moderate group, and 15% in the severe group (P=0.154). In Cox multivariate regression analysis, a lack of a history of infertility [hazard ratio (HR)=0.633, P=0.001] and tubal scoring (mild HR=2.408, P=0.008; moderate HR=2.147, P=0.010) were significantly associated with a higher rate of spontaneous intrauterine pregnancy. Having a history of infertility (HR=0.351, P=0.037) and no prior abdominopelvic surgery (HR=2.907, P=0.014) were significantly associated with a lower ectopic pregnancy rate., Conclusion: The new tubal classification system significantly correlated with spontaneous pregnancy outcomes in patients with tubal pregnancy following laparoscopic salpingostomy., (Copyright © 2016. Published by Elsevier Ireland Ltd.)

Intra-abdominal drains have been used since long to prevent intra-abdominal collection, and detect any anastomotic leaks. We report a case of left sided fallopian tube herniation from a left lower abdominal drain site in a 27-year female who underwent caesarian section for breach presentation. Several complications related to drain usage has been described but left sided fallopian tube prolapse through drain site has not been reported in literature.

Introduction: Prolapse of the fallopian tube after hysterectomy is a rare but known complication. Cases of prolapse of the fallopian tube through the vaginal vault have been reported after abdominal, vaginal or laparoscopic hysterectomies. This is the first case report to the best of our knowledge on the prolapse of a fallopian tube through an abdominal wound after caesarean section., Case Presentation: We report a case of the prolapse of the fimbrial end of a fallopian tube through an abdominal scar after caesarean section mimicking scar endometriosis. A 24-year-old primipara South Asian woman of Punjabi ethnicity presented to our institute with a fleshy mass protruding through her abdominal scar and bleeding from the mass during menstruation for the past 5 months. She underwent a caesarean section 6 months earlier for breech presentation. Her history revealed she had wound dehiscence on the sixth postoperative day. The major portion of her wound healed in 1 month leaving a 2 cm area in the middle of her vertical scar. An abdominal examination revealed a 2×2 cm fleshy mass protruding through the middle part of her infraumbilical abdominal scar. At the time of the surgery we found that the fimbrial end of her left fallopian tube was protruding through her abdominal scar., Conclusion: Awareness of this complication may prevent improper management of wound dehiscence and such complication causing prolonged agony to the patient.

Background: Hysteroscopic sterilization procedure has gained traction in the past decade as a means of contraception advertised to be 99.83% effective following successful sterilization coil placement and postprocedure hysterosalpingogram confirmation of proper coil positioning and tubal occlusion., Case: A 44-year-old female underwent a second sterilization procedure after delivering a pregnancy that occurred following a reportedly successful hysteroscopic sterilization procedure and subsequent confirmatory testing demonstrating appropriate sterilization coil placement and tubal occlusion. During the second sterilization procedure, a coil device was visible perforating through the left uterine cornua., Conclusion: Following hysteroscopic sterilization, confirmatory testing may demonstrate the appearance of tubal occlusion and proper coil placement when the sterilization devices are incorrectly placed and the fallopian tubes patent., (Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.)

Objective: Tubal patency in women with endometriosis has traditionally been evaluated by laparoscopy. The aim of this study was to investigate the accuracy of hysterosalpingo-contrast-sonography (HyCoSy) in the assessment of tubal patency in these women., Study Design: A retrospective study was conducted at Physiopathology of Human Reproduction Unit. Infertile women who underwent HyCoSy and then a laparoscopy (dye test) within 6 months from the HyCoSy were included. Tubal patency was assessed by HyCoSy and the findings were compared with the results of laparoscopy, which was considered the gold standard for assessment of tubal patency. Sensitivity, specificity, positive and negative predictive values (PPV, NPV) and positive and negative likelihood ratios (Lh+, Lh-) were calculated including the 95% confidence interval (CI)., Results: A total of 1452 women underwent HyCoSy and 126 of them received a laparoscopy within 6 months from the HyCoSy. Of the 126 women, 42 (33.3%) had a diagnosis of pelvic endometriosis and 84 (66.7%) had no endometriosis. In the endometriosis population, HyCoSy showed a sensitivity, specificity, PPV, NPV, Lh+ and Lh- of 85% (95% CI 62-96), 93% (95% CI 82-97), 81% (95% CI 58-94), 94% (95% CI 84-98), 12.6 (95% CI 4.8-33) and 0.15 (95% CI 0.05-0.4) respectively. In the non-endometriosis group, HyCoSy showed a sensitivity, specificity, PPV, NPV, LR+ and LR- of 85% (95% CI 65-95), 93% (95% CI 87-96), 71% (95% CI 53-85), 97% (95% CI 92-99), 13.2 (95% CI 6.9-25) and 0.15 (95% CI 0.06-0.3) respectively. The diagnostic accuracy of HyCoSy was 91% in the endometriosis group and 92% in the non-endometriosis patients., Conclusions: HyCoSy showed high accuracy in evaluating tubal patency in infertile non-endometriosis women and in those affected by endometriosis., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

The ectopic endometrial tissues lining the lumen of the fallopian tubes are currently defined as either "endometrial colonization" or "endometriosis" on the basis of their location within or beyond the isthmic portion of the fallopian tubes. The underlying etiology is unclear. The goal of this study was to define the fallopian endometrial lesions pathogenetically rather than anatomically. We investigated 39 cases of the ectopic endometrial tissues within the fallopian tubes, most of which exceeded the isthmus. Immunohistochemical analysis was performed to evaluate the expression of Cox-2, NF-κB, and VEGF, which are specifically expressed by classic endometriosis. Other clinicopathologic parameters were also recorded. The results indicated that the lesions that were confined to the mucosa might differ from those observed in the muscular or serosal layers, which showed significantly less surrounding inflammatory reaction and less concurrent salpingitis and other endometriotic lesions. The expression of Cox-2, NF-κB, and VEGF of the ectopic endometrial stromal cells tended to increase in the progression from the inner to the outer part of the tubes with significance. The expression of NF-κB and VEGF correlates with the microscopic findings of inflammation. Sterilization by tubal ligation exhibited a unique pattern of distribution. Except in those patients with tubal ligation, considering the different expression patterns observed in the tubal ectopic endometrial lesions, the mucosal type should be diagnosed as "endometrial colonization" wherever the lesion occurs. The others should be diagnosed as "endometriosis" to reveal the etiology identical to typical endometriotic lesions.

Background: Prolapse of the fallopian tube into the vaginal vault is a rarely reported complication that may occur after hysterectomy. Clinicians can miss the diagnosis of this disregarded complication when dealing with post-hysterectomy vaginal bleeding., Objectives: We performed a systematic review in order to describe the clinical presentation, therapeutic management and outcome of fallopian tube prolapse occurring after hysterectomy., Search Strategy: A systematic search of MEDLINE and EMBASE references from January 1980 to December 2010 was performed. We included articles that reported cases of fallopian tube prolapse after hysterectomy. Data from eligible studies were independently extracted onto standardized forms by two reviewers., Results: Twenty-eight articles including 51 cases of fallopian tube prolapse after hysterectomy were included in this systematic review. Clinical presentations included abdominal pain, dyspareunia, post- coital bleeding, and/or vaginal discharge. Two cases were asymptomatic and diagnosed at routine checkup. The surgical management reported comprised partial or total salpingectomy, with vaginal repair in some cases combined with oophorectomy using different approaches (vaginal approach, combined vaginal-laparoscopic approach, laparoscopic approach, or laparotomy). Six patients were initially treated by silver nitrate application without success., Conclusions: This systematic review provided a precise summary of the clinical characteristics and treatment of patients presenting with fallopian tube prolapse following hysterectomy published in the past 30 years. We anticipate that these results will help inform current investigations and treatment.

Background: Pelvic infection, unsafe abortion and previous laparatomy are risk factors for tubal infertility among Nigerian women. Reports on the relationship between these factors and tubal pathology seen on hysterosalpingography (HSG) from our environment have been few., Objective: To assess the prevalence of tubal occlusions among patients referred for HSG and examine the association between previous history of abdominopelvic surgery (including dilatation and curettage for abortion) and tubal occlusion., Methods: We studied one hundred and thirty women referred to the Radiology department for HSG because of infertility. HSG was performed during the early proliferative phase of the menstrual cycle. Information about type and duration of infertility, history of abdomino -pelvic surgery and history suggestive of previous pelvic infection, were obtained from the patients. The data obtained were analyzed using SPSS version 11. Test of association using the chi-square test was done where appropriate and differences were considered at p= 0.05., Results: Sixty one women had bilaterally patent tubes; tubal pathology was seen in sixty nine women. Significant association exits between tubal pathology and history of pelvic surgery p=0.01, pelvic infection p=0.02 and duration of infertility p=0.04., Conclusion: Previous surgery especially dilation and curettage, PID duration and type of infertility are associated with tubal pathology among Nigerian women. Creative methods of lowering the cost of diagnosis and management of tubal occlusion need to be instituted.

Aim: The aim of this study was to observe the insides of the fallopian tubes of patients with unilateral or bilateral endometriomas by using salpingoscopy and evaluate the inner cavity of the fallopian tubes according to our original scoring system., Material and Methods: From April 2008 through December 2010, patients with unilateral or bilateral endometriomas were recruited (n = 157, endometrioma group). All patients underwent laparoscopic ovarian cystectomy and salpingoscopy. Using salpingoscopy, we observed the tubal lumen and calculated a fallopian tube score (F score) paying attention to the following six results: adhesions, loss of mucosal folds, rounded edges of mucosal folds, debris, foreign bodies, and abnormal vessels. The F scores were compared with those of the unexplained infertility patients who received those same procedures during the same period (n = 235; control group)., Results: Slightly more than three-quarters (75.9%) of the patients in the endometrioma group received F scores of 0, and this percentage was significantly higher than that for the control group (139/235 = 59.1%, P < 0.05). The pregnancy rate after conventional treatment for the endometrioma group was 21.7%, and all pregnant patients had achieved an F score of less than 2., Conclusion: It is highly possible that infertility patients with ovarian endometriomas are more likely to have intact fallopian tubes, by comparison with infertility patients who do not have ovarian endometriomas., (© 2013 The Authors. Journal of Obstetrics and Gynaecology Research © 2013 Japan Society of Obstetrics and Gynecology.)

Herein are presented 2 cases from the last 5 years. In case 1, a fallopian tube intussusception without perforation, misdiagnosed as a myoma, was observed at hysteroscopy of the uterine cavity 18 months after last vacuum aspiration. In case 2, a fallopian tube incarceration, misdiagnosed as a placental polyp, was observed 3 months after last suction curettage. Although uterine perforation caused by suction curettage after abortion or of afterbirth occurs rarely, it is a complication that must be taken into account because after this procedure there may be painful symptoms such as the typical triad of abdominal pain, vaginal discharge, and dyspareunia. In some situations, as in case 2, amenorrhea occurs alone, without other distressing symptoms. In both cases, a hysteroscopic approach was used; laparoscopy was necessary only in case 2., (Copyright © 2011 AAGL. Published by Elsevier Inc. All rights reserved.)

Chlamydia trachomatis poses a potential threat to the fertility of women by causing tubal damage. Many women with serological evidence of past Chlamydia infection have normal tubal appearances on laparoscopic assessment. The aim of this study was to assess if serological evidence of past chlamydial infection affects the likelihood of conception in women with normal tubes. Infertile couples in which the female partner was under the age of 40 years, with normal ovulatory function and a male partner with normal sperm function were studied. All women had normal tubes as assessed by laparoscopy. Serum Chlamydia antibody titres were assayed using the immunofluorescence test. Pregnancy rates were related to grouped Chlamydia antibody titres (<64, 64-256 and > or =512). A total of 174 women were studied. The cumulative pregnancy rates (SE) according to these titres were 45.1% (6.2), 42.6% (9.3), 59.1% (11.8) and the risk ratios (95% confidence interval) were 1, 1.59 (0.82-3.07) and 1.04 (0.52-2.08) respectively. The differences were not statistically significant. Therefore, in women with normal-looking tubes, serological evidence of past chlamydial infection does not appear to have an adverse effect on pregnancy rates. These findings suggest that laparoscopic findings and not Chlamydia serological titres are the key to prognosis.

Introduction: Inguinal hernias commonly occur during infancy. They are approximately six times more common in males than in females. They are one of the most common surgical conditions in childhood. About 5-20% of inguinal hernias have the ovary or fallopian tube in the hernia sac. Surgical interventions during childhood may cause damage. Unawareness of this damage can cause infertility in future., Case Report: Presentation of a case diagnosed as having tubal damage during laparoscopic operation because of primary infertility with a history of inguinal hernia during her childhood. Inguinal hernia repair caused tubal damage and bilateral tubal occlusion as a cause of primary infertility., Conclusion: Medical history is of great importance during infertility investigation and may reveal some unexpected conditions.

A 34-year-old woman presented with an intermittent abdominal pain 5 years after voluntary vacuum aspiration for interruption of a first-trimester pregnancy. Magnetic resonance imaging demonstrated complete septate uterus and a cystic mass that infiltrated the posterior myometrial wall of the right side of the uterus. Laparoscopy and hysteroscopy revealed an intra uterine fallopian tube incarceration.

Migration of an intrauterine device (IUD) is a complication occurring at or following insertion. After having perforated the uterine wall, the IUD usually will settle into the peritoneal cavity. Tubal migration of an IUD is extremely rare and little is known about its mechanism. We describe a case of pyosalpinx caused by the tubal migration of a copper IUD. The tail of the device was embedded in the mesocolon.

Some complications of hysterocopy have been reported with increasing practice of the procedure both for diagnostic and operative procedures. However, complications associated with office hysteroscopy (HS) have not been well documented. A 35-year-old woman was accepted at our center for a second IVF cycle. She had had a history of primary infertility for nine years and no presumptive factors as a cause of infertility had been documented. Office hysteroscopy revealed a regular endocervix, endometrial cavity and bilateral internal tubal ostia. The patient was evaluated by pelvic examination (without any evidence of pelvic inflammatory disease) and transvaginal ultrasonograhy one month after the office HS for routine evaluation before the IVF cycle. There was an image compatible with left hydrosalpinx (6 mm in diameter) in her ultrasonographic examination that had not been detected before by the same physician using the same ultrasound equipment. Following an informative consultation with the patient, laparoscopy was performed and left hydrosalpinx was diagnosed. Salpingectomy was then carried out. The diagnosis of hydrosalpinx was confirmed by histological examination. To the best of our knowledge this is the first report of hydrosalpinx possibly caused by an office HS procedure.

Background: The aim of the present study was to identify a possible association between tubal pathology and the contraceptive methods previously used, especially third generation copper intrauterine devices (IUDs)., Method: In this retrospective unmatched case-control study, use of contraceptive methods and Chlamydia trachomatis antibody titres were compared in women with tubal occlusion (n = 84) and infertile women with tubal patency (n = 253) demonstrated by hysterosalpingography. Contraceptive methods were also compared to primiparous women with natural pregnancy., Results: A significantly higher percentage of women with tubal occlusion had previously used an IUD. Positive C. trachomatis antibody testing was found significantly more often in women with tubal occlusion. Neither hormonal contraceptives nor condoms were associated with an increased risk for uni- or bilateral tubal occlusion., Conclusion: In the present study, we observed an increased rate of tubal occlusions in previous IUD users. This should be considered in the contraceptive counseling of young and nulliparous women.

Objective: To determine the outcome of tubal surgeries at the University of Nigeria Teaching Hospital. Enugu, Nigeria over a 15 year period (1990 - 2004)., Method: A retrospective case series review., Results: Sixty-four women underwent tubal surgery in the hospital within the 15 year period. Hydrosalpinx was the most frequent tubal pathology occurring in 35 (54.7%) of the women followed by peritubal adhesions in 13 (20.3%) women and cornual block in 11 (17.2%) women. The surgical access was through laparotomy in 59 (92.2%) women and laparoscopy in 5 (7.8%) women. Fifty-seven (89.1%) of the cases had macrotubal surgery while 7 (10.9%) women had microtubal surgery. Twenty-four (37.5%) women had cuff salpingostomy, 16 (25%) had peritubal adhesiolysis, 12 (18.8%) had linear salpingostomy while 10 (15.6%) had tubo-cornual anastomosis. The most frequently used suture for tuboplasty was chromicised catgut No 2/0 which was used in 46 (71.9%) of the women. Twenty-five (39.1%) women were followed up for more than 6 months while the rest were lost to follow-up after 6 months. Three of the 25 women followed-up for more than 6 months became pregnant giving a pregnancy rate of 12.0% for this sub-group and an overall pregnancy rate of 3/64 or 4.7%., Conclusions: Tubal surgery as seen at the University of Nigeria Teaching Hospital Enugu has a low pregnancy rate similar to ones reported from other Nigerian centres. If attention is paid to the currently recommended microsurgical techniques, the pregnancy rates following tubal surgery are likely to be better than has been documented in this study.

Prolapse of the fallopian tube into the vagina is an uncommon complication caused by either vaginal or abdominal hysterectomy. Recently, however, we encountered three cases with prolapse of the fallopian tube after abdominal hysterectomy. The patients presented with vaginal bleeding. A red hemorrhagic granular mass, misdiagnosed as vaginal granulation tissue both macroscopically and microscopically, was noted at the apex of vagina. Pathologically, one case was initially diagnosed as vaginal vault granulation tissue, but there were two recurrences after excision. Microscopically, the mass had a papillary or villous outer surface with a complex pattern of tubular and glandular structures, as well as acute and chronic inflammatory infiltrates in the fibrovascular stroma. A typical ciliated tubal type of epithelium was identified, and on immunohistochemical staining for cytokeratin, attenuated epithelial cells were detected. It is necessary to receive a pathologic confirmation by performing vaginal biopsy when fallopian tube prolapse is clinically suspected, thus preventing misdiagnosis.

Because it usually presents with nonspecific symptoms and occurs rarely, the diagnosis of fallopian tube torsion and necrosis is usually done at laparotomy. A 32 year-old woman returned to the hospital with right lower quadrant pain three days after a postpartum tubal sterilization procedure. Clinical, laboratory and imaging findings did not assist with the diagnosis. At laparotomy, after dissection of adhesions, a necrotic right fallopian tube was found. A salpingectomy was performed and the patient had an uneventful postoperative course. Fallopian tube torsion should be included in the differential diagnosis of pelvic pain in women. This patient has a good prognosis.

Prior experiments have shown that the functioning of hamster oviducts is impaired by in vitro exposure to cigarette smoke. To determine if cigarette smoke affects oviductal functioning in vivo, an inhalation experiment was done in which hamsters were exposed to doses of smoke similar to those received by human smokers. The effects of mainstream smoke (the bolus of smoke inhaled by active smokers) and sidestream smoke (the main component in environmental tobacco smoke) were compared. Transport of preimplantation embryos through the hamster oviduct was retarded in females inhaling doses of mainstream or sidestream smoke that produced serum cotinine levels within the range reported for women who actively or passively smoke during pregnancy. In addition, hamster oviductal muscle contraction rate decreased significantly during a single exposure of animals to either mainstream or sidestream smoke, and contraction rate failed to return to initial control values during a 25-min recovery period. Both preimplantation embryo transport and muscle contraction were more sensitive to sidestream than mainstream smoke. These data demonstrate that inhalation of doses of mainstream and sidestream cigarette similar to those received by active and passive human smokers adversely affects functioning of the oviduct and may explain the increased incidence of ectopic pregnancies reported in women who smoke.

Among 18 cases of endometriosis involving ovaries and fallopian tubes, we identified three cases with foci of endometriosis adjacent to the embryonic duct remnants in the fallopian tube. The serial sections of the blocks of tissue containing areas of interest showed segments of embryonic duct remnants with changes suggestive of gradual transformation to endometrial glands. The early changes consisted of replacement of the muscular coat surrounding the epithelium of embryonic duct remnants by the endometrial stroma with positive immunoreactivities for estrogen receptor. Subsequently there were changes of the embryonic duct remnant epithelium into endometrial epithelium with diffuse immunoreactivities for estrogen receptor. The significance of this transformation as a mechanism of development of endometriosis is discussed.

Objective: To investigate effectiveness and cost of transcervical salpingography and recanalization in the management of infertility caused by tubal occlusion., Design: Retrospective analysis of patients investigated with transcervical selective salpingography and, in some instances, treated by transcervical recanalization., Setting: Four hundred patients with hysterosalpingography diagnosis of obstructed fallopian tubes (clinical environment) are investigated. A repeat hysterosalpingogram after administration of a prostaglandin antagonist demonstrated patency of the tubes in 82 patients and selective transcervical salpingography demonstrated patency in an additional 131 patients., Intervention: Transcervical tubal recanalization. Of the remaining 187 patients, recanalization by transcervical technique was successful in 145 patients. The underlying etiology for tubal obstruction was salpingitis isthmica nodosa in 62, salpingitis and perisalpingitis in 71, endometriosis in 8, failed surgical anastomosis in 43, and undeterminate cause in 3 patients. Pregnancy was attained in 24 patients, there were 10 minor and 1 major complication., Outcome Measure: Attained and maintained patency of tubes, pregnancy, attendant complications., Conclusion: A pregnancy rate of 12.8% was attained after transcervical recanalization of obstructed tubes. An attendant increased rate of pregnancy in patients proven patent after selective salpingography, valuable detailed information about proximal and distal tubes after recanalization of the obstructed proximal tube segment, the low rate of complications, and low cost are factors recommending the use of this technique. Moreover, tubal surgery or IVF treatment are not influenced adversely by prior transcervical tubal recanalization and remain an option for patients who failed to attain pregnancy.

This is a report on a new method of microsurgical transposition of the Fallopian tube. It was developed to deal with congenital malformations or with the different anatomic remnants after pelvic surgery or pelvic inflammatory diseases. The tube is mobilised by severing the mesosalpinx with the unipolar microelectrode without damaging the longitudinal vessels. After mobilisation, the bends of the tube disappear and the length increases almost doublefold. Then the tube can be laid to the contralateral ovary without any tension. The tube must be fixed to the ovary in such a way, that the fimbrial end is mobile enough to lay onto the ovary during ovulation. Up to now, six patients with longstanding tubal sterility were operated upon. Three of them became pregnant, one twice. There were no ectopic pregnancies and no abortions.

Objective: To correlate the severity and extent of pelvic adhesions, as noted at laparotomy for microsurgery, with the presence and extent of fallopian tube intraluminal pathology, as noted using salpingoscopy., Design: Prospective clinical study., Setting: A university teaching hospital., Patients: Twenty patients presenting for pelvic microsurgery between July 1992 and January 1993., Interventions: Salpingoscopy was performed at the time of microsurgery and intraluminal pathology was scored. An objective assessment of the extent of pelvic adhesions was made using standardized adhesion score systems., Results: There was a strong correlation between the degree of intratubal damage and the extent of pelvic adhesions when the etiology was previous pelvic inflammatory disease (PID) but not when the underlying etiology was endometriosis. However, in the endometriosis subgroup, intraluminal ampullary pathology was noted in 27% of tubes assessed, and intraluminal fimbrial pathology was noted in 36% of tubes assessed. Intraluminal tubal pathology also was noted in a number of cases where the underlying etiology was previous surgery for benign disease., Conclusions: This study confirms previous reports that, in cases of PID leading to adhesions, there is a high incidence of intraluminal pathology. However, this study also demonstrates that intraluminal pathology is often associated with adhesions arising from other etiologic groups, suggesting that intraluminal assessment is required for all patients in whom adhesiolysis for fertility is considered.

The Authors describe a rare case of IUD tubal migration. The uterine device had been inserted twelve years before. A hysteroscopical removal of the IUD was tried unsuccessfully, because it was impossible to locate it either in the uterine cavity or at the fallopian tube orifice level. The patient underwent a minilaparotomy and the IUD was found out at the peritubal level. An ecographic control of all intrauterine devices insertions is recommended.

Laparoscopic laser surgery is becoming increasingly common as treatment for endometriosis. We report a case of computed tomographic (CT) demonstration of salpingoureteral fistula secondary to laparoscopic laser surgery.

The data on the results of surgical treatment of tubal infertility in 104 patients are presented. In 52 of these cases the operations were conducted according to a developed method with the use of microsurgical techniques. A modified plastic surgery of the ampullar-fimbrial part of the uterine tube made it possible to achieve a 13% increase in restoring the patency of the uterine tubes as well as a 9% improvement of childbearing function. The experiments on rabbit does led to a conclusion that with the ampullar-fimbrial part of the uterine tube cut off, the pregnancy was still possible, but to a lesser degree.

Hydrosalpinx proved macroscopically and microscopically which was quite similar to that observed in the damage human fallopian tube could be induced by ligation of the rabbit fallopian tube. Where ligatures have been placed on two places of the fallopian tube, hydrosalpinx can be induced in 100 percent of cases if ligation is done securely. About 1-2 weeks after ligation, no change of ciliated cells was observed in the mucosal fold in SEM findings, nor was there much change in the external shape of non-ciliated cells even though hydrosalpinx was induced. With the lapse of time after development of hydrosalpinx, however, both of these cells on the surface of the mucosal fold gradually changed to loose their normal shapes. After 15 weeks, ciliated cells all but disappeared to be replaced by large, filled, irregular non-ciliated cells. Accordingly, hydrosalpinx in the early stage can be cured fully by tubal salpingostomy using microsurgery. In the case of hydrosalpinx many hours after ligation, however, end-to-end anastomosis of the normal regions should be performed since no recovery can be expected.

The efficacy of two nonsteroidal antiinflammatory drugs, ibuprofen and indomethacin, in the prevention of postoperative adhesions was examined. Thirty-three guinea pigs were randomly divided into three groups: a control group (n = 11), an ibuprofen group (n = 11), and an indomethacin group (n = 11). All of the animals received standardized injuries, and adhesions were graded 4 weeks later. Both treatment groups were found to have significantly fewer (P less than 0.01) adhesions when compared with the control group with no difference among the two treatment groups. It is concluded that ibuprofen and indomethacin are equally effective in reducing postoperative adhesions.

Twenty five patients were operated on for isthmic tubal occlusion. In 15 cases (60%) the etiology of this lesion was salpingitis isthmica nodosa. Of the other 10 cases, three showed tubal endometriosis and another three isthmic fibrosis. In two patients the histologic examination showed chronic inflammation. In one case etiology was tubal tuberculosis and in one case a cyst of calcified Gartner 's duct was seen. Inflammatory etiology seems to be important in isthmic tubal occlusion. In many cases chlamydial infection may be the chronic irritant which also cause the muscular hypertrophy leading to salpingitis isthmica nodosa.

Because there is disagreement as to how linear ampullary salpingotomy should heal, primarily or secondarily, we compared the two methods with the use of rabbit oviducts in which conditions simulating ectopic pregnancy had been induced. Pregnancy rates (86% versus 75%), nidation indices (62% versus 54%), and percentage of adhesion-free tubes (50% versus 32%) were greater after primary closure, but these differences were not statistically significant. Ampullary tuboperitoneal fistulae occurred at the site of operation in 6.8% of tubes and impaired fertility (P less than 0.005).

Chlamydial inclusions were found in the luminal epithelium of all segments of the oviducts (ostium, ampulla, and isthmus) of mice experimentally inoculated with the mouse pneumonitis (MoPn) biovar of Chlamydia trachomatis. Electron microscopy of infected oviducts revealed chlamydial inclusions in both ciliated and nonciliated cells of the oviduct epithelium. Inclusions contained typical elementary, intermediate and reticulate bodies as well as numerous "miniature reticulate bodies" and membrane ghosts. Small, vesicle-like structures were observed in infected cells near inclusions but were not seen in apparently uninfected cells nor in the oviducts of mice inoculated with the control (sterile tissue culture supernate) suspension. Chlamydia-like particles were seen in vacuoles of polymorphonuclear leukocytes. Intracellular Chlamydia-like particles were not seen in any other cell type in the mouse oviduct. Infection of the mouse oviduct with MoPn is a convenient model for the study of C. trachomatis morphology in vivo.

Proximal tubal lesions that are discovered when a case of sterility is being worked out are polymorphic in nature and they are variable in extent. Fortunately it is rare that a proximal tubal lesion should involve the whole interstitial portion and the uterine os of the tube. This is why many surgeons have taken up the method of tubo-uterine implantation advocated by Palmer. Salat-Baroux and Cornier published a paper on microsurgical tubo-interine implantation in 1979. We since 1978 have been carrying out a technique of tubo-uterine anastomosis in raquette shape (mostly isthmo-uterine). This is described in detail in this article. The first results on 32 anastomose carried out in 23 patients who were operated on of whom 17 cases had pure cornual lesions and 6 cases bipolar lesions seem to be encouraging with a patency rate 6 months later of 69% and a rate of intra-uterine pregnancy of 23.2% (0.10-0.41) at 12-18 months and 31.1% (0.14-0.56) at 18-24 months (using an actuarial method). Up to now we have not had an extra-uterine pregnancy near the site of suture. Our technique seems to us to give a worthwhile alternative microsurgical method to implantation in interstitial lesions that are widespread and deep.

Ligation of the ovarian end of the oviduct was used to induce hydrosalpinges in rabbits and monkeys. This procedure resulted in an accumulation of clear serous fluid within the lumen and distention of the ampullary wall. The ampullary endosalpinx responded with a general flattening of the surface architecture, especially a decrease in the prominence of the longitudinal mucosal folds. However, this flattened epithelial surface showed normal ciliation. Two to five months after ligation, direct observations were made in vivo of luminal transport of cumulus egg masses and surrogates. These observations were followed by study in vitro of ciliary currents on the exposed luminal surface. The results demonstrated conclusively that tubal dilatation had no adverse effect on cilia-mediated ovum transport within the ampulla. The implication of these results in terms of tubal infertility is discussed.

In 137 oviducts of New Zealand white rabbits different kinds of occlusion techniques were tested to induce hydrosalpinges. In 99 oviducts ligatured or clipped both at the fimbrial end and at the ampullary-isthmic junction 67 hydrosalpinges were achieved, whilst in 34 oviducts ligatured or clipped only at the fimbrial end one hydrosalpinx occurred. Most severe histological changes were seen after double clipping. Ligation of the blood vessels to and from the ampulla of 4 oviducts caused no hydrosalpinx formation. After cuff salpingostomy a higher number of patent oviducts was found than after double-loop salpingostomy.

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.

A comparative evaluation of three different techniques (Madlener's, Wood's and Filshie Clip Mark IV) for female sterilization was carried out in adult female rhesus monkeys with the aim of finding out the efficacy and the extent of tissue damage in the fallopian tube. The severity of pathological changes would indicate the chances of future successful reversal. The experiment was carried out in two phases. In Phase-I, no post-operative antibiotics were given whereas in Phase-II in addition to post-operative antibiotics, two sham-operated controls were also kept. This study revealed that the Filshie's clip is associated with significantly (p less than 0.01-0.001) greater tissue damage of the fallopian tubes with formation of dense adhesions as compared to the Madlener's or Wood's technique. Further, Filshie's clip had slipped off from 4 tubes out of 14 tubes where it was applied.

The discrepancy between pregnancy and patency rates after salpingostomy is explained largely by the residual functional damage to both the mucosa and smooth muscles of the fallopian tube. The function of the ovary after salpingostomy has not been extensively studied. Hydrosalpinx was mechanically induced by double clip application in thirty adult female New Zealand white rabbits. After varying periods of hydrosalpinx formation, ampullary-isthmic anastomosis and cuff-salpingostomy were carried out using full microsurgical techniques. The animals were mated 1 week after surgery. Ten days after mating, laparotomy was performed. The contralateral oviducts and oviducts from unoperated animals served as controls 1 and 2 respectively. Corpora lutea counts and ovarian venous estradiol 17B (E2) and progesterone (P) levels were measured to assess ovarian function. The mean values (+/- s.e.) for corpora lutea count on Control 1, Control 2 and operated sides were 6.46 +/- 0.43, 5.69 +/- 0.44 and 4.03 +/- 0.32 respectively. The mean values for E2 and P were 159.0 +/- 17.43 and 281.769 +/- 13.58; 133.75 +/- 18.45 and 265.89 +/- 18.12; 128.57 +/- 14.66 and 206.103 +/- 13.296 respectively. Only the differences between the mean number of corpora lutea and mean progesterone were statistically significant (P less than 0.001) (0.02 greater than P greater than 0.01) respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Damage to fallopian tubes caused by hydrosalpinges is a major reason for persisting infertility. We describe the mucosal changes that occur following induction of experimentally induced hydrosalpinges in 25 rabbits. Ampullary biopsies obtained at varying intervals were examined with light microscopy and scanning and transmission electron microscopy. Mucosal folds showed progressive atrophy. The epithelium was flattened. The population of ciliated cells decreased and, finally, deciliation became generalized. The morphology of nonciliated cells changed from an initial high content of granules of secretion to a final stage of vacuolated cytoplasm. Cell desquamation was common.

Neisseria gonorrhoeae and Chlamydia trachomatis are the common bacteria isolated from bacterial cervicitis and are the leading etiological agents for pelvic inflammatory disease. Neisseria gonorrhoeae cause infection of the mucosa of fallopian tubes in organ culture by attaching to microvilli of nonciliated cells, phagocytosis by these cells, transport across and exocytosis from the epithelial cells. In contrast the Chlamydia attach to the epithelial surface without apparent ligand binding and are taken into the cytoplasm of the epithelial cell. Exocytosis of Chlamydia is into the tubal lumen and not into the subepithelial spaces. The ciliated epithelial cells of the fallopian tube are damaged by a gonococcal toxin but chlamydia do not exhibit such activity. These observations suggest that the mechanism of attachment to and invasion of the mucosal epithelium by gonococci and chlamydia are quite different and their potential for disease production occurs by different methods.

The authors used a scanning electron microscope to study epithelial damage to the rabbit fallopian tube after sterilization with different methods and its subsequent capacity to regenerate after recanalization. Thirty female NZW rabbits were divided into five groups and sterilized using the following methods: 1) Madlener 2) Pommeroy, 3) clips, 4) unipolar coagulation, 5) bipolar coagulation. Each group was divided into subgroups of two and submitted at differing intervals to a second laparotomy, during which one tube was removed and the other anastomosed according to Winston's method. Four weeks after the second laparotomy all the rabbits were sacrificed, the remaining tube removed, and all tubes examined with the scanning electron microscope. The results indicate that mechanical methods of occlusion such as clips offer greater recovery possibilities than those in which the lesion is extended to the mesosalpinx. There further exists a correlation between the time that elapses after sterilization and regeneration of the epithelium.