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Endometriosis and the development of tuboperitoneal fistulas after tubal ligation.

Abstract：

:The present study details gross and histologic findings of 79 previously ligated fallopian tubes from 3 groups of patients. Of 20 oviducts removed after documented sterilization failure (group I), 6 revealed a process compatible with endometriosis. Four of nine previously ligated fallopian tubes removed at the Johns Hopkins Hospital (group II) were successfully injected with India ink. In two patients histologic examination demonstrated the India ink in epithelium-lined spaces that lay beyond the muscle of the tubal wall extending from the tubal lumen to the serosal surface. Fifty oviducts were studied in twenty-five patients requesting reversal of their sterilizations (group III). A higher percentage of fistulas was demonstrated in patients with less than 4 cm of remaining proximal tubal segment. Furthermore, most of these fistulas were demonstrated in patients for whom 3 years had elapsed since the original sterilization procedure. Patients sterilzed by laparoscopic cautery methods were observed to have a higher percentage of fistula formation and histologic documentation of endometriosis at the sterilization site as compared with patients sterilized by other methods. Our observations suggest that ligation of the oviduct within 4 cm of the uterine cornu may predispose to the development of endometriosis and subsequent fistula formation in the tip of the ligated oviduct. :Gross and histological findings of 79 previously removed fallopian tubes from 3 groups of patients are reported. Of 20 tubes removed after documented sterilization failure (Group 1), 6 showed endometriosis. 4 of 9 previously ligated tubes (Group 2), were injected with ink; 2 patients showed ink in epithelium-lined spaces beyond the muscle of the tubal wall from the tubal lumen to the serosal surface. Group 3 was 50 oviducts from 25 patients requesting reversal of sterilizations. In this group a higher percentage of fistulas was demonstrated in those with less than 4 cm of tube remaining in the proximal segment. Also, most of these fistulas were in patients 3 years or more away from the original procedure. Laparoscopic cautery sterilizations had higher percentages of fistula formation and endometriosis at sterilization site than sterilizations by other methods. Therefore, ligation of the fallopian tube within 4 cm of the uterine cornu may predispose development of endometriosis and subsequent fistula formation at the tip of the ligated tube.

journal_name

Fertil Steril

journal_title

Fertility and sterility

authors

Rock JA,Parmley TH,King TM,Laufe LE,Su BS

doi

10.1016/s0015-0282(16)45251-9

subject

Has Abstract

pub_date

1981-01-01 00:00:00

pages

16-20

issue

eissn

0015-0282

issn

1556-5653

pii

S0015-0282(16)45251-9

journal_volume

pub_type

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Endometriosis and the development of tuboperitoneal fistulas after tubal ligation.