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Salpingectomy versus neosalpingostomy in women with hydrosalpinx: a prospective cohort study with long-term follow-up
  • +8
  • li yan,
  • Chenfeng Zhu,
  • Guiling Liang,
  • chuqing he,
  • liang yan,
  • xiaoya zhao,
  • Xiaoqing He,
  • Yiqin Zhang,
  • Ben Mol,
  • Jian Zhang,
  • Judith Huirne
li yan
International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University

Corresponding Author:[email protected]

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Chenfeng Zhu
International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University
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Guiling Liang
International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University
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chuqing he
International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University
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liang yan
International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University
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xiaoya zhao
International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University
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Xiaoqing He
International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University
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Yiqin Zhang
International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University
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Ben Mol
Monash University Medical Centre
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Jian Zhang
International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University
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Judith Huirne
Amsterdam Reproduction and Development Research institute, Amsterdam University Medical Centre, location AMC and VUmc
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Abstract

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´╝ÜSalpingectomy 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.