Salpingectomy versus neosalpingostomy in women with hydrosalpinx: a
prospective cohort study with long-term follow-up
Objective: To compare postoperative reproductive outcomes between
salpingectomy and neosalpingostomy for bilateral severe hydrosalpinges.
Design: Single center, prospective cohort study. Setting: A hospital
affiliated to a medical college in China. Population: Women aged 20 to
45 years old, diagnosed with bilateral hydrosalpinges and scheduled for
surgery were initial eligibility criteria. Women with previous tubal
surgery or tubal pregnancy, no fertility intention, or no confirmation
of severe bilateral hydrosalpinges during surgery were excluded.
Methods: Bilateral salpingectomy or neosalpingostomy was performed based
on a shared decision approach. Main outcome measures: The primary
outcome was the cumulative livebirth rate. Secondary outcomes included
time to first live birth, biochemical pregnancy, clinical miscarriage,
ectopic pregnancy, mode of conception, and gestational age at delivery.
Results: A total of 113 women were involved in the analysis. When the
result of In Vitro Fertilization (IVF) in the neosalpingostomy group was
incorporated, salpingectomy resulted in a higher cumulative livebirth
rate (85.3% vs 76.0%, hazard ratio of the whole survival curve = 2.18,
95% CI 1.37 - 3.45), a lower risk of ectopic pregnancy (1.8% vs
20.7%, risk ratio = 0.07, 95% CI 0.01 - 0.57), and a shorter time to
live birth than neosalpingostomy. 16/58 (27.6%) women in the
neosalpingostomy group had a live birth via natural conception, compared
to 0/55 (0.0%) in the salpingectomy group. Conclusions：Salpingectomy
for bilateral severe hydrosalpinges resulted in a higher cumulative
livebirth rate and a lower risk of ectopic pregnancy. However,
neosalpingostomy can offer certain option for women to conceive
naturally without IVF treatment.