Transcervical fallopian tube catheterization and recannalization for proximal tubal obstruction under guide of hystroscopy and laparoscopy

Summary and ConclusionFemale infertility still constitutes one of the common problems in gynecologic practice and special investigative techniques for evaluating the cervix, uterus, fallopian tubes and pelvis have become increasingly popular among gynecologists.This study included 53 infertile females reffered to the Endoscopy Unit of Obstetrics & Gynecology Department, Zagazig Univerity Hospital for evaluation of their condition by Hysteroscopy and /or Laparoscopy .All patients were subjected to carful history taking, general and pelvic examination ,HSG must be done withen 6 months before refferal .Then diagnostic hysteroscopy was done with emphasis on the cornual ostia to see it is patent or blocked. Then the patient is admitted to the theater if needed and possible .Hysteroscopic tubal cannulation will be done under guidence of laparoscopy .In this study 45 patients with PTO(26 unilaterl and 19 bilateral PTO )afte exclusion of 8 cases diagnosed by laparoscopy as distal tubal obstruction .Hysteroscopic tubal cannulation was done guidance of laparoscopy in 64 PTO FTs, 33 FTs had successfully cannulated (13 unilateral and 20 20 bilateral )while the other 31 FTs failed cannulation .(13 unilateral and 18 bilateral )which is not signifecant .Pregnancy rate 6 months following success of cannulation was 56.53 %913 interauterine pregnancy out of 23 patients )and one tubal pregnancy 4.34 % is recorded while the other cases not recorded themselves .It could concluded that :Hystersalpingography, hysteroscopy and laparoscopy complement each other in the evaluation of female infertility rather than competing. .Hysteroscopic tubal cannulation:Have higher interauterine pregnancy rates and lower ectopic pregnancy rates .It is less invasive, effective and relatively safe.Requires a much shorter learning curve and its results are much less dependent on surgical technique than microsurgical resection anastomosis .Hysteroscopic tubal cannulation under laparoscopic guidance offers the option for individualized patient management and should be the treatment of choice for PTO.It is also a therapeutic option when PTO develops subsequent to an initially successful resection anastomosis 0r tubal cannulation procedures.