Discussion on Modern Methods of Salpingostomy

A personal series of tubal reconstruction cases is reported. Results and procedures of 396 consectuvie salpingostomies performed by the author between 1942 and 1959 are considered. 15.2% were called complete successes; 30% showed evidence of failure (reocclusion or stenosis) by insufflation; 5% resulted in ectopic (tubal) pregnancies; and 33% of cases though patent by insufflation produced no pregnancies within a year. Postoperative adhesions occurred at a rate of less than 10%. Results varied with time: from 1942-1951 16.6% resulted in uterine pregnancy (complete success) and 2.2% in extrauterine pregnancies from 1951-1956 11.6% had uterine pregnancies and 7.2% had extrauterine pregnancies; and from 1956-1959 25.9% had uterine pregnancies postoperatively 7.4% had extrauterine pregnancies and 49% showed normal patency. The main difference in rates seems attributable to the use of oral prednisolone postoperatively. 4 absolute contraindications are indicated: 1) any other obvious factor of sterility in husband or wife; 2) women over 37 years old; 3) recent acute or subacute inflammation; and 4) probability of tuberculosi as the cause of occlusion. Salpingostomy techniques are described and 4 main types are outlined: 1) codonolysis; 2) terminal salpingostomy; 3) medio-ampulla salpingostomy; and 4) isthmic salpingostomies. Polyethylene tubing was never used in this series. The postoperative use of prednisolone (Hydrocortancyl for 6 weeks) seems to have increased the efficacy of the operation.