Gökhan TOSUN, Mehmet ADIYEKE, Alper İLERİ, Yaşam Kemal APAK

Laparoskopik Tubal Reanostomozda Gebelik Oranları: 2. Basamak Merkezin Deneyimleri

Amaç: Laparoskopik tubal reanastomoz işlemi uygulanan hastaların demografik ve cerrahi özellikleri ile laparoskopik tubal reanastamoz işlemi sonrası üreme sonuçlarını değerlendirmeyi amaçadık. Gereçler ve Yöntem: Laparoskopik tubal reanastomoz yapılan 28 hastanın dosyaları retrospektif olarak incelendi. Hastaların yaşı, doğum sayısı, geçirilmiş cerrahi öyküsü, tubal sterilizasyon yöntemi, sterlilizasyon sonrası geçen süre, laparoskopik reanastomoz işlemi sonrası gebelik oranları, operasyon süresi, operasyon sırasında meydana gelen komplikasyonlar değerlendirildi. Bulgular: Hastaların yaş ortalaması 35.9±4 yıl, tubal sterilizasyon sonrası geçen ortalama süre 5.28±2 .41 yıl olarak saptandı. Laparoskopik tubal reanastomoz işlemi süresi ortalama 210,42± 68,7 dakika idi. Toplam gebelik, intrauterin gebelik, biyokimyasal gebelik ve ektopik gebelik oranları sırasıyla %21,4, %7.14, %7.14 ve %7.14 olarak saptandı. Gelişmiş olan iki intrauterin gebelikten biri 8. gebelik haftasında missed abortus olması nedeniyle kürete edildi, diğeri canlı doğum ile sonlandı. Sonuç: Laparoskopik tubal reanastomoz, iyi bir ön değerlendirme sonrası uygun hastada yapılması gereken, ileri derece cerrahi deneyim ve beceri gerektiren bir işlemdir.

Pregnancy Rates in Laparoscopic Tubal Reanostomosis: Experiences of Second Stage Center

Objective: We aimed to evaluate the demographic characteristics, surgical characteristics and post-reanastomosis fertility results of patients undergoing laparoscopic tubal reanastomosis. Material and Methods: Data of twenty-eight patients undergoing laparoscopic tubal reanastomosis were retrospectively studied. Patients' age, number of deliveries, history of previous surgeries, tubal sterilization method, duration after tubal sterilization, pregnancy rate after laparoscopic tubal reanastomosis, duration of operation, complications during operation were evaluated. Results: The mean age of the patients was 35.9 ± 4 years and the mean time after tubal sterilization was 5.28 ± 2.41 years. The mean duration of operation was 210.42 ± 68.7 minutes. Total pregnancy, intrauterine pregnancy, biochemical pregnancy and ectopic pregnancy rates were 21.4%, 7.14% , 7.14% and 7.14% respectively. Missed abortion was occurred in two intrauterine pregnancy and dilatation-curettage was performed, the other was live birth. Conclusion: Tubal reanastomosis is a procedure requiring advanced surgical experience and skill, which must be performed in appropriate patients. We think that this procedure should be done by experienced surgeons with adequate equipment at appropriate patients.

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1- Daniels K, Daugherty J, Jones J, Mosher W. Current Contraceptive Use and Variation by Selected Characteristics Among Women Aged 15-44: United States, 2011-2013. Natl Health Stat Report. 2015;(86):1-14.
2- Gordts S, Campo R, Puttemans P, Gordts S. Clinical factors determining pregnancy outcome after microsurgical tubal reanastomosis. Fertil Steril. 2009;92(4):1198-202.
3- Liskin L, Rinehart W, Blackburn R, Rutledge AH. Minilaparotomy and laparoscopy: safe, effective, and widely used. Popul Rep C. 1985;(9):C125-67.
4- Trussell J, Guilbert E, Hedley A. Sterilization failure, sterilization reversal, and pregnancy after sterilization reversal in Quebec. Obstet Gynecol. 2003;101(4):677-84.
5- Gomel V, McComb PF. Microsurgery for tubal infertility. J Reprod Med. 2006;51(3):177-84.
6- Berger GS, Thorp JM Jr, Weaver MA. Effectiveness of bilateral tubotubal anastomosis in a large outpatient population. Hum Reprod. 2016;31(5):1120-5.
7- Van Seeters JAH, Chua SJ, Mol BWJ, Koks CAM. Tubal anastomosis after previous sterilization: a systematic review. Hum Reprod Update. 2017;23(3):358-370.
8- Malacova E, Kemp-Casey A, Bremner A, Hart R, Stewart LM, Preen DB. Live delivery outcome after tubal sterilization reversal: a population-based study. Fertil Steril. 2015;104(4):921- 926
9- Sreshthaputra O, Sreshthaputra RA, Vutyavanich T. Factors affecting pregnancy rates after microsurgical reversal of tubal sterilization. J Reconstr Microsurg. 2013;29(3):189-94.
10- Ribeiro SC, Tormena RA, Giribela CG, Izzo CR, Santos NC, Pinotti JA. Laparoscopic tubal anastomosis. Int J Gynaecol Obstet. 2004;84(2):142-6.
11- Yoon TK, Sung HR, Kang HG, Cha SH, Lee CN, Cha KY. Laparoscopic tubal anastomosis: fertility outcome in 202 cases. Fertil Steril. 1999;72(6):1121-6.
12- Rouzi AA, Mackinnon M, McComb PF. Predictors of success of reversal of sterilization. Fertil Steril. 1995;64(1):29-36.
13- Dubuisson JB, Chapron C. Single suture laparoscopic tubal re-anastomosis. Curr Opin Obstet Gynecol. 1998;10(4):307- 13.
14- Bissonnette F, Lapensée L, Bouzayen R. Outpatient laparoscopic tubal anastomosis and subsequent fertility. Fertil Steril. 1999;72(3):549-52.
15- Ribeiro SC, Tormena RA, Giribela CG, Izzo CR, Santos NC, Pinotti JA. Laparoscopic tubal anastomosis. Int J Gynaecol Obstet. 2004;84(2):142-6.
16- Yoon TK, Sung HR, Cha SH, Lee CN, Cha KY. Fertility outcome after laparoscopic microsurgical tubal anastomosis. Fertil Steril. 1997;67(1):18-22.