chapter  12
28 Pages

Distal Tubal Obstruction: surgery and ART

Tubal surgery to relieve obstruction dates to the 1880s. In 1895, Martin reported 62 cases of distal salpingostomies. The procedure entailed a fenestration at the distal obstruction. Two pregnancies and two deaths from postoperative peritonitis were described in this series.1 Pregnancy rates in early reports after repair for distal obstruction were uniformly poor and ranged from 0 to 15%.2 Poor pregnancy rates, however, were not the only cause for concern. The most sinister complication was an ectopic pregnancy, a clinical event associated at the time with appreciable mortality.3 From the 1930s, various techniques for tubal repair appeared in the literature. In 1932, the first description of a distal salpingostomy with eversion of the distal tubal segment was reported, providing practitioners with a reliable and reproducible technique of exposing the distal tubal segment.4