In the surgical correction of hydrosalpinx, the CO2 laser offers some advantages, including precision of application, minimal bleeding, rapid healing, and minimal scar formation. It remains to be seen whether the pregnancy rate in “laser patients” is superior to that in patients who have had other kinds of surgery. The purpose of the present investigation was to compare the results of salpingostomy performed by three different methods: CO2 laser, micro-diathermy needle, and conventional surgery. The study was divided into two parts. In part 1, 45 women (20–36 years of age) with hydrosalpinx were studied. In order to ensure homogeneity in patient groups, only those women with complete bilateral terminal tube occlusions were included. Preoperative infertility investigations included semen analysis, basal body temperature measurement, postcoital test, hysterosalpingographic examination, timed endome-trial biopsy, and serum progesterone determination. The patients were then randomly assigned to undergo salpingostomy by CO2 laser (23 patients) or by microdiathermy needle (22 patients). No significant difference was found in the degree of tubal disease between the laser group (5.3 ± 0.7) and the nonlaser group (4.7 ± 0.3). When the degree of tubal disease was compared between patients who conceived and those who did not, no significant difference was found in either the laser or the nonlaser group (Table 1). When the data from the laser and the nonlaser group were combined, there was a significant difference in the degree of tubal disease between patients who conceived and those who did not (Table 1). The outcome of pregnancy in the two groups is shown in Table 2. A significantly shorter surgery-conception interval was found in the laser group than in the nonlaser group (Table 2). Part 2 of the investigation involved a retrospective study of 45 women (20–37 years of age) with bilateral hydrosalpinx. The inclusion and exclusion criteria were similar to those of part 1. Salpingostomy in this group of patients was done conventionally with cold instruments (scissors). The mucosal flap was everted with 6–0 Vicryl sutures.
Sheehan's syndrome and diabetes insipidus were diagnosed in a 31-year-old woman seven months after postpartum bleeding with a short duration of hypotension. The diagnosis of diabetes insipidus was established by the inability to concentrate urine during water deprivation and the marked increase in urinary osmolality after administration of 1-Desamino-8-D-arginine-vasopressin (DDAVP). Obstetricians should be aware of diabetes insipidus as a postpartum complication.
To evaluate the effects of Ringer's lactate instillation and amniotic membrane on adhesion formation and reformation, 30 Sprague-Dawley rats were subjected to a standardized lesion by serosal denudation of the proximal uterine horn and devascularization of that segment. The rats were assigned randomly into control, Ringer's lactate, and amniotic membrane groups. The amniotic membrane was first treated with trypsin. At the second laparotomy, adhesions were scored and liberated, and the rats with adhesion score of more than 4 were assigned randomly into the three groups as previously described. Adhesion formation and reformation were significantly lower in the Ringer's lactate than in the control group. The adhesion formation score was higher in the control group than in the amniotic membrane group. The adhesion reformation score, however, was not significantly different. These findings suggest that in our animal model, Ringer's lactate instillation reduces adhesion formation and reformation. Trypsin-treated amniotic membrane reduces adhesion formation but not reformation. (J GYNECOL SURG 8:247, 1992)
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