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2015년 유럽불임학회(ESHRE) P-769 Almost half of unilateral hydrosalpinx need additional contralateral fallopian tubal surgery (일측 난관수종이 있는 경우, 거의 절반의 경우 반대쪽 난관에 이상이 있어 추가적인 수술이 필요하다.)
H. G. Sun1, K. H. Lee1, I. H. Park1, H. J. Chi1, S. G. Kim1, K. H. Maeng1, S. J. Kwak1, J. Y. Park1
1Mamapapa&baby Obstetrics Gynecology Clinic, OB&GY, Ulsan City, South Korea
When we perform unilateral salpingectomy due to unilateral hydrosalpinx on HSG, is really contralateral fallopian tube normal?
With a unilateral hydrosalpinx on HSG, abnormalities in contralateral fallopian tube were found in 45.6% and performed additional surgeries salpingectomy or fimbrioplasty.
Tubal factor is about one third causes of infertility. For tubal factor evaluation, the most commonly used tests are hysterosalpingography (HSG) and laparoscopy. HSG has high specificity for diagnosis of tubal occlusion and low sensitivity in cases with peritubal adhesions. Tubal patency on HSG does not necessarily indicate normal tubal function. Among women with patent tubes on HSG, 18% were found to have tubal obstruction or peritubal adhesions on laparoscopy.
This retrospective study included 178 salpingectomy cases due to hydrosalpinx on HSG between January 2010 and December 2014.
Total 178 cases salpingectomy were performed. 99 cases were excluded (69 cases - bilateral salpingectomy due to bilateral hydrosalpinx, 30 cases – unilateral salpingectomy due to unilateral hydrosalpinx with contralateral tubal obstruction on HSG/previous salpingectomy).
We analyzed 79 cases with unilateral hydrosalpinx and contralateral normal patency on HSG. Among 79 cases, 43 cases were performed only unilateral salpingectomy (US). 14 cases were performed US and contralateral salpingectomy due to unexpected hydrosalpinx. 22 cases were performed US and contralateral fimbrioplasty or adhesiolysis due to peritubal adhesion or abnormal result on dye test. Therefore in case of unilateral hydrosalpinx on HSG, 45.6% (36/79) were found abnormality of contralateral tube and needed additional surgery.
The subjectivity of radiologists may be involved in interpretation of HSG. Also during operation, the subjectivity of surgeon may be involved in decision making of contralateral tubal surgery.
An abnormal tubal condition affects negatively natural pregnancy or IVF outcomes, therefore proper surgery is needed. Among women with normal tubes on HSG, 18% were found abnormalities on laparoscopy. But with unilateral hydrosalpinx, proportion of requiring opposite fallopian tubal surgery is increased by 45.6%. Therefore, in case of elective unilateral salpingectomy due to unilateral hydrosalpinx on HSG, operators must examine opposite tube carefully and make full explanation about incidental bilateral salpingectomy and possibility of IVF.