Postablation-tubal sterilization syndrome

Operative resectoscopy and endometrial ablation are often performed to treat abnormal uterine bleeding, but little is known about the potential late complications of these procedures. We reviewed the records of 305 women who underwent endometrial ablation at a midwestern obstetrics and gynecology group practice and teaching hospital between July 1990 and October 1995. For 71 women, tubal ligation, salpingectomy, or tubal sterilization was performed at the time of ablation. Of these, six (8.4%) developed intense cyclic pain 5 to 40 months after surgery. Four subsequently underwent exploratory laparotomy and hysterectomy, and two others underwent laparoscopic tubal resection and destruction. Gross pathologic findings revealed hematosalpinx, and microscopic examination showed endometriosis, acute and chronic inflammation of the fallopian tubes, and acute and chronic myometritis. We believe these characteristic clinical and pathologic findings are consistent with postablation-tubal sterilization syndrome, a distinct clinical entity arising as a late complication of endometrial ablation in patients with a history of tubal ligations and/or obstruction.

Improved combined laparoscopic and minilaparotomy technique to allow for reversal of extensive tubal sterilization

We assessed the efficacy of combined laparoscopic and minilaparotomy for outpatient microsurgical reversal of extensive tubal sterilization in 11 women undergoing the procedure and followed for a mean of 24.7 months. All patients desired reversal of extensive tubal sterilization, and had 4 cm or less of the longer oviduct remaining. The mean operating time was 110 minutes, and the mean total cost was $5067. There were no major complications. Two women were treated for uncomplicated cystitis within 1 month of surgery. Five (45%) of 11 women delivered viable infants; one patient had two ectopic pregnancies. These preliminary data suggest that outpatient combined laparoscopy and minilaparotomy may be effective in patients who desire restoration of fertility after extensive tubal sterilization.

Live birth after treatment of severe adenomyosis with a gonadotropin-releasing hormone agonist

A patient with a 10-year history of secondary infertility underwent GnRH-a therapy with LA for 5 months to control symptoms of severe adenomyosis and to avoid an unwanted hysterectomy. Shortly after cessation of treatment, the patient conceived. A healthy male was delivered at term by cesarean section, which makes this the first report of a live birth after treatment of severe adenomyosis with a GnRH-a.