M C Bowman1, I D Cooke. 1. University Department of Obstetrics and Gynaecology, Jessop Hospital for Women, Sheffield, United Kingdom.
Abstract
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.
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.
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