Vasectomy: subclinical pathologic changes.

The nature of the local histopathologic changes secondary to vasectomy is described in tissue excised at vasovasostomy in 37 secondarily infertile patients. Segments of surgically removed vasa were also studied in four patients with primary infertility who underwent scrotal explorations and subsequent vasoepididymostomy. Except for infertility, all patients were asymptomatic. Three, often concurrent, inflammatory or proliferative changes were found in 50 of 76 segments of vasa deferentia. These included suture granuloma, sperm granuloma, and vasitis nodosa, the last being a ductular proliferation originating from the central vas lumen and extending into the perivasal soft tissues. Vasitis nodosa occurred in 66% of the patients, and although it was often found with a sperm granuloma, it did occur by itself and is a lesion which should be recognized.

Post-ligation dilatation of the fallopian tube.

RATIONALE AND OBJECTIVES: Dilatation of fallopian tube remnants after ligation has been described but never systematically studied in post-ligation hysterosalpingograms (HSGs). This study describes the frequency and appearance of proximal tubal remnant dilatation as seen on HSGs in women with a history of bilateral tubal ligation (BTL). METHODS: A retrospective review of medical records and a subjective and objective evaluation of dilatation seen on HSGs included 68 consecutive women seen for pre-reanastomosis HSG. RESULTS: Among the 68 women, 44 (67%) had objectively measured dilatation on one or both tubes. Dilatation was present in both short and long tubal remnants. There were no measurable differences between women with and without presence of dilatation. Neither length nor dilatation of tubal remnant was associated with pregnancy outcome. CONCLUSIONS: Dilatation of the tubal remnant after bilateral tubal ligation is a common finding on HSG and can be accurately identified from the HSG by radiologists. Dilatation is not strictly related to length, and in our small sample with follow-up, was not associated with pregnancy outcome.

Reduced levels of T suppressor/cytotoxic lymphocytes in semen from vasovasostomized men: relationship to sperm autoantibodies.

The regulation of lymphocyte populations in semen and their function remains unknown. Using monoclonal antibodies and immunohistochemical techniques we compared the levels of mononuclear cells in ejaculates obtained from 14 men with intact vas deferens and 13 men who had undergone both a vasectomy and a microsurgical vasovasostomy. The presence of antisperm antibodies was also assessed by the immunobead binding assay. Semen from both groups contained about 10(3) T and B lymphocytes and monocytes. In men with intact vasa, T suppressor/cytotoxic cells predominated. In contrast, in vasovasostomized men the levels of T suppressor/cytotoxic cells were significantly reduced (P less than 0.005) and T helper/inducer cells predominated in their semen. Concentrations of seminal T helper/inducer lymphocytes, B lymphocytes and monocytes were similar in both groups. Antisperm antibodies were detected on sperm, in seminal fluid and/or in serum of all the vasovasovasostomy patients but in none of the controls, T suppressor/cytotoxic cells may limit the immune response to sperm within the male reproductive tract. Chronic obstruction resulting in damage to the integrity of the excurrent ducts may induce alterations in T cell regulation leading to a decrease in T suppressor/cytotoxic cells and create conditions permissive for the formation of autoantibodies to sperm-specific antigens.

Temporal recognition of sperm autoantigens by IgM and IgG autoantibodies after vasectomy and vasovasostomy.

Temporal patterns of IgM and IgG autoantibodies to sperm proteins were studied by western blot analysis at intervals after bilateral vasectomy, vasectomy followed one month later by vasovasostomy, or sham operations. Responses were detected to eight major autoantigens at 21-23, 36, 41, 51, 57, 63, 68-71 and 75-83 kDa, by study of staining patterns of sequential serum samples from individual animals and by analysis of the incidence of reaction to each protein. The four lower molecular weight antigens (21-23, 36, 41 and 51 kDa) provoked mainly IgG responses. The strongly stained set of higher molecular weight antigens (57, 63, 68-71 and 75-83 kDa) tended to show more clearly defined temporal patterns of IgM followed by IgG response, including a high incidence of IgM antibody at the 2-week interval. Three of the larger peptides (57, 63 and 68-71 kDa) appeared highly immunogenic, since some reactions were detected even in sham-operated rats. The classical patterns of IgM and IgG antibody responses to the majority of the dominant sperm autoantigens are in accord with the hypothesis that vasectomy mimics immunization with spermatozoa. The high incidence of IgM antibodies in the earliest sample, taken 2 weeks after vasectomy, suggests that the initial immunizing event takes place within about a week after the operation. Vasovasostomy did not bring about a decrease in antisperm antibodies. Instead, some animals demonstrated an increased reaction to certain antigens after reversal of vasectomy, even though the vasovasostomies were anatomically successful.

PIP: The production of antisperm antibodies is common subsequent to vasectomy and antisperm antibodies frequently persist following the reversal of vasectomy. The number of such antibodies may even increase after vasovasostomy. Using adult male Lewis rats, the authors analyzed the dominant autoantigens which evoke IgM and/or IgG autoantibodies after vasectomy by western blotting (WB) methods, the temporal patterns of IgM and IgG autoantibodies to specific sperm proteins, and the influence of vasovasostomy upon IgM and IgG antisperm autoantibodies. The temporal patterns were studied by WB at intervals after bilateral vasectomy, vasectomy followed 1 month later by vasovasostomy, and fake operations. Responses were detected to 8 major autoantigens of 21-23, 36, 41, 51, 57, 63, 68-71, and 75-83 kDa through the study of staining patterns of sequential serum samples from individual animals and by analysis of the incidence of reaction to each protein. The 4 lower-molecular-weight antigens provoked mainly IgG responses, while the strongly stained higher-molecular-weight antigens showed more clearly defined temporal patterns of IgM followed by IgG response, including a high incidence of IgM antibody at the 2-week interval. The peptides of 57, 63, and 68-71 kDa seemed to be highly immunogenic, since some reactions were detected even in rats which received only a fake operation. Results support the hypothesis that vasectomy mimics immunization with spermatozoa, while the high incidence of IgM antibodies in the earliest sample, taken 2 weeks after vasectomy, suggests that the initial immunizing event occurs within approximately 1 week after the operation. Vasovasostomy caused no decrease in antisperm antibodies.

Pregnancy rates after reconstructive surgery on the fallopian tubes.

PIP: Current practices at Johns Hopkins Hospital with regard to surgery for tubal disease are presented. Statistical support for a particular point could not always be provided, but overall end results are given. Between 1965 and 1972, 66 patients at the Johns Hopkins Hospital had tuboplasties: 24 salpingolyses, 18 fimbrioplasties, 6 anastomoses, 8 cornual implantations, and 10 multiple procedures. The average patient age was 29.3. The duration of infertility was between 8 months and 10 years, with an average of 53.2 months. 41 of the patients had primary and 25 had secondary infertility. The operations of lysis of adhesions were done for patients whose hysterosalpingograms or dye studies at endoscopy showed patent tubes where peritubal adhesions were visualized. Fimbrioplasty has proved to be the most frustrating operation. Resection and anastomosis was almost exclusively done for repair of the tubes after surgical ligation. A high percent of good results are expected after cornual implantation. The pregnancy rates after correction of obstruction at various sites were 58% for salpingolysis, 22% for fimbrioplasty, 50% for midtubal obstructure, 38% for cornual implantation, and 20% for multiple procedures. The overall pregnancy rate was 39.4%. These rates depended on the length of the followup: the shorter the duration of followup, the lower the pregnancy rate. In order to circumvent this problem, expectancies of pregnancy, when followed up for an indefinite time, were calculated by computer. By this algorithm, it was found that 50% of patients could expect pregnancy following tuboplasties of all kinds: 66% after tubolysis, 40% after fimbrioplasty, 50% after anastomosis, 38% after cornual implantation, and 21% after multiple procedures.^ieng

Microsurgical two-layer vasovasostomy: word of caution.

Microsurgical technique, with separate mucosal and muscular layer anastomosis, recently has been advocated as the most successful method of vasovasostomy. Unexpected difficulties may be encountered using this method; moreover, considerable practice in the microsurgical laboratory is mandatory before actual performance of the procedure. As with any innovation in surgical technique, a judgment of the clinical superiority of the two-layer anastomotic method must await substantiating results from other investigators.

PIP: A microsurgical technique, with separate mucosal and muscular layer anastomosis, has been advocated as the most successful vasovasostomy method presently available. But the 2-layer microsurgical vas anastomosis has aspects that are foreign both to the urologist and to the experienced microvascular surgeon, and suggestions are made for mastering this microtechnique. For the urologist, practice on sheet rubber edges followed by vessel anastomosis in small animals are prerequisite to successful surgical outocme. For the microvascular surgeon, certain changes must be made from usual practices because of the stiffness, thickness of wall, and small size of lumen compared with the outer diameter of vas deferens. A summary of attempts made at 2-layer anastomosis suggests that the 2-layer method in a laboratory model appeared superior to a single-layer method. Final judgement of superiority of this 2-layer technique cannot be pronounced.

Microsurgical reconstruction of the uterin tube in sterilized patients.

Increasing requests for reversal of sterilization prompt a re-evaluation of guidelines for sterilization and for methods of reconstruction. The method of nonmicroscopic (gross) reconstruction is examined, and its frequent failures are felt to be in consequence of surgically induced distortion and damage to physiologic function. Microsurgery minimizes these failings and results in a doubled pregnancy rate. Microsurgical procedures are described and illustrated, and criteria are given for selection of candidates.

PIP: The most frequent reason given for requests for tubal reconstruction has been divorce followed by a desire to produce children with a new spouse. Methods of nonmicroscopic tubal reconstruction have had frequent failures due to surgically induced distortion and damage to physiologic function. Microsurgery minimizes these adverse effects. A doubled subsequent pregnancy rate has resulted. Patency, as determined by hysterosalpingography between 3-6 months postoperatively, was improved from 50% in gross surgery operations to 91.7%. About 50% of those requesting tubal reconstruction have been rejected, usually because too much tubal damage had been done by the previous sterilization operation. Microsurgical technique requires use of the binocular operating microscope. Loupe lenses are not adequate. The suture material is 10-0 Ethilon, a black monofilament nylon. Several special instruments are also needed. Further details of the technique employed are given. Greater caution against injudicious sterilization is advised. Only reversible types of sterilization operations are recommended. When surgical reversal is indicated, microsurgery offers the best hope of success.

Epididymal extravasation following vasectomy as a cause for failure of vasectomy reversal.

Twenty-eight men undergoing vasectomy reversal who were found to have no sperm in the proximal vas fluid on one or both sides underwent microscopic epididymal exploration. In 33 of 39 cases so explored, normal sperm were found in the epididymal fluid of the corpus, despite absence of sperm in the vas fluid. Epididymal histology distal to this site revealed extensive interstitial sperm granulomas resulting from rupture of the epididymal duct. Testicular biopsy revealed normal spermatogenesis. Secondary epididymal obstructions were noted when there was copious fluid in the vas deferens proximal to the vasectomy site as well as when there was scanty fluid. It is concluded that persistent azoospermia after an accurate microscopic vasovasostomy results from the secondary epididymal obstruction induced by rupture of the epididymal duct related to the pressure increase after vasectomy.

PIP: 28 men underwent microscopic epididymal exploration and serial transections with biopsy. All of these men were noted to have no sperm in the vas fluid on the testicular side of the vasectomy site at the time of intended vasovasostomy. The age range of the patients was 27-55 years. All patients underwent several semen analyses preoperatively to determine that they were azoospermic. In 11 of these 28 patients the need for epididymal exploration was bilateral; in 17 the exploration was only unilateral. Thus, a total of 39 epididymides were examined. In 33 of the 39 cases, despite absence of sperm in the vas fluid, an abundance of sperm was noted in the epididymal fluid at some point between the junction of the tail of the epididymis with the corpus epididymidis and the area of the proximal corpus epididymidis. Epididymal histology distal to this site showed extensive interstitial sperm granulomas resulting from rupture of the epididymal duct. Testicular biopsy revealed normal spermatogenesis. Secondary epididymal obstructions were noted when there was copious fluid in the vas deferens proximal to the vasectomy site as well as when there was scant fluid. Persistent azoospermia after an accurate microscopic vasovasostomy results from secondary epididymal obstruction induced by the rupture of the epididymal duct related to the pressure increase after vasectomy.

Reanastomosis of the previously ligated fallopian tube.

Tubal sterilization procedures are being performed on young women in increasing numbers. For a variety of reasons a small but significant number of women are requesting reversal of the tubal interruption. This report presents a series of 20 consecutive patients on whom tuabl reanastomoses of previously noncoagulated, surgically ligated fallopian tubes were performed. An intraluminal tubal suture technique is described. Low magnification (X2 to X4) was used. The comparative results of the patients operated upon revealed a tubal pregnancy rate of 80%, a total pregnancy rate of 70%, a viable pregnancy rate of 55%, three abortions, and one ectopic pregnancy.

PIP: A series of patients who underwent surgical end-to-end reanastomosis of previously ligated fallopian tubes is presented. The technique was highlighted by use of intraluminal suture under relatively low magnification (times 2 or times 4). Pre-, post-, and operative data are presented tabularly for the 20 women represented in this series. 80% (16 of 20) had patent tubes, and 70% became pregnant (14 of 20); 15% of these aborted and 1 lost her pregnancy to ectopic complication. Therefore, 55% had viable pregnancies. The time interval from ligation to reanastomosis ranged from 5 months - 13 years. The time interval from reanastomosis to pregnancy ranged from 1-31 months (mean 8 months), and reasons for requesting reanastomosis ranged from improved economic status to remarriage.

Vasovasostomy: a comparison of macroscopic and microscopic techniques at one institution.

During a 5-year period between 1973 and 1977, 87 patients underwent vasovasostomy to correct postvasectomy sterility. Sixty-one patients had single-layer macroscopic reanastomoses and 26 patients had two-layer microscopic reanastomoses. Patency rates of 90% and 96% and pregnancy rates of 46% and 54% for the macroscopic and microscopic techniques were achieved.

PIP: The experience with macroscopic and microscopic reanastomoses was compared in a series of 87 patients ages 24-53 who underwent vasovasostomy to reverse a previous vasectomy. The average interval since vasectomy was 5 years. 61 of these patients had single-layer macroscopic reanastomoses and 26 patients had 2-layer microscopic reanastomoses. Criteria for inclusion in the study were availability for 1-year follow-up, sterility secondary to vasectomy, and a report of pregnancy validated by a sperm count. Patients with congenital and inflammatory vasal occlusions and vasoepididymal anastomoses were excluded. 41 patients in the macroscopic technique group met these criteria. Spermatozoa were present in the ejaculates of 37 patients, for a patency rate of 90%. There were 19 pregnancies in this group, yielding a pregnancy rate of 46%. Of the 26 patients in the microscopic technique group, 25 had spermatozoa in their ejaculate, for a 96% patency rate. There were 14 pregnancies, yielding a 54% pregnancy rate. The discrepancy noted in this series between the patency and pregnancy rates is consistent with results of other research. Analysis of data collected in this series suggests that a low pregnancy rate is associated with a low sperm count. Men with sperm counts 35 million achieved ad 25% pregnancy rate compared with a 77% rate for men with counts 35 million. In addition, patients presenting for vasectomy reversal 2 years after vasectomy had a 100% patency rate and an 88% pregnancy rate overall. Comparison of the rates for the 2 techniques suggests only a slight advantage to use of the microscope. Factors other than technique may be involved in pregnancy achievement. However, use of the microscope is favored so that convoluted vas and epididymis can be explored in cases where the lumen in the cut and of the vas is not enlarged or where no sperm are found in the fluid from the cut end. It is predicted that the microscopic technique will provide better pregnancy rates in the future as experience is accumulated.

Tubal reanastomosis: an update.

PIP: 53 self-selected cases of tubal reanastomosis are summarized and followed up. Only patients who had been sterilized by the Pomeroy sterilization method were chosen for this reanastomosis procedure. All but 3 of the cases were performed with a single-side repaired. The longest, least scarred tube with the fewest adhesions was chosen for reanastomosis. The procedure is described. Various techniques were used to confirm patency following the procedure. Follow-up results of the 53 cases are presented in tabulated form. The cases exhibited a high pregnancy rate (64%), a high viable birth rate (47%), and a low tubal pregnancy rate (15%). The high success rate of this series is attributed to the preservation of tubal tissue through a Pomeroy sterilization procedure and a lack of intraluminal material at the repair site. In the 3 cases in which both tubes were repaired, a tubal pregnancy preceded an intrauterine pregnancy.^ieng

Femoral nerve compression injury and tubal microsurgery.

PIP: A survey was made of doctors to determine if femoral nerve compression injury, an uncommon complication of laparotomy, is more common in tubal microsurgical reconstruction. Questionnaires were sent to persons in North America known to have performed tubal reconstructions. In the 6 or 7 individuals who provided information, a total of 5 femoral nerve injuries were reported in 1620 cases, for an incidence of 1 in 324. All nerve damage occurred with the O'Connor-O'Sullivan retractor. Tubal microsurgery differs from laparotomies and predisposes to femoral nerve damage because of: 1) necessity of a wide incision, placing the lateral blades of the retractor closer to the area of the nerve; 2) necessity of stabilizing the operating hand; 3) requirement of tilting the patient toward the operator; 4) length of time required for the procedure. The following precautions are presented: 1) avoid using the O'Connor-O'Sullivan retractor for tubal reconstruction, particularly in thin patients; 2) when placing the retractor, check the relationship of the lateral blade to the area of the nerve with downward and outward pressure on the retractor; and 3) use an arm rest during surgery.^ieng

Tubal anastomosis of a fimbrial segment pedicle graft.

PIP: A 32-year-old gravida 4, para 4, was seen at the University of Wisconsin Hospital in 1976 requesting reversal of her tubal sterilization. She had undergone a colpotomy with removal of 1.8 cm of each Fallopian Tube (confirmed histologically) in 1970. A laparotomy in 1975, for abdominal pain, resulted in the removal of a hemorrhagic ovarian cyst, but the pathology report did not mention the distal 1.8 cm of the right Fallopian Tube as being part of the surgical specimen. A short time later, 3 of the patient's children died in a house fire. At laparoscopy, the right tube was unencumbered, measuring 6 cm from the cornu to its blunt end. On the left, a short (less than 5 mm) segment of the tube at the cornu and a normal fimbrial segment were visualized. The intervening portion of the tube was absent. Laparotomy was undertaken with the intent of performing a left cornual-ampullary anastomosis, but, when the cornual segment was shaved, a definitive lumen could not be identified. Anastomosis of the left fimbrial segment to the right proximal fallopian tube as a pedicle graft was performed without the aid of magnification. Five 6-0 Dexon sutures were placed in a through-and-through manner involving secrosa, muscularis, and mucosa. A final 4-0 silk suture brought the two mesosalpinges together at the base of the tube. The patient was treated with dexamethasone and phenergan. 18 months following surgery, the patient conceived. A 9-month pregnancy ended in spontaneous labor and the vaginal delivery of a healthy infant.^ieng

On the reanastomosis of fallopian tubes after surgical sterilization.

PIP: A macrosurgical technique for tubal reanastomosis is described in detail. It has been used successfully on 12 patients in the last year, 10 of whom have already become pregnant. The technique is suitable for different methods of sterilization, sites of anastomosis, and lengths of segments. The procedures are characterized as isthmic-isthmic, isthmic-ampullary, and ampullary-ampullary. 2 patients had isthmic-isthmic operations; both had had Pomeroy sterilizations. Both became pregnant and delivered at term. 7 patients had isthmic-ampullary operations; 2 had had Pomeroy sterilization and 5 had had laparoscopic diathermy. 5 have normal pregnancies at the time of report; the 2 nonpregnant women have at least 1 patent tube. 3 patients had ampullary-ampullary operations; all had had Pomeroy sterilizations involving only the ampulla. All have become pregnant but 1 had a tubal pregnancy distal to the site of the anastomosis, which was somewhat constricted while the other tube was patent. Intervals from operation to pregnancy were 6 and 9 months for isthmic-isthmic; 2, 3, 7, 9, and 10 months for isthmic-ampullary; and 2, 3, and 7 months for ampullary-ampullary. The procedure should be carried out in the proliferative phase of the menstrual cycle.^ieng

Problems with tubal reconstruction following laparoscopic sterilization using the electrocoagulation and resection technique.

This paper reviews the results of attempted tubal reconstruction following laparoscopic sterilizations using the electrocoagulation and excision technique in the isthmic portion of the fallopian tube. The surgical technique, complications, and results are presented.

PIP: Tubal reconstruction was attempted on 11 patients who had undergone extensive thermocoagulation and division of the tube in the isthmic portion. Extensive counseling, gynecologic history, physical examination, Papanicolaou smear, basic laboratory tests, and hysterosalpingogram were conducted prior to surgery. If diagnostic laparoscopy revealed less than 4 cm of tube remaining on both sides, pelvic laparotomy and tubal reconstruction were not attempted. Only 1 patient had sufficient proximal Fallopian tube to allow a salpingosalpingostomy; in 10 patients tubal reanastomosis was not possible and tubal reimplantation was performed. The surgical technique is described. A postoperative pelvic abscess developed in 1 patient; postoperative hysterograms have shown total obstruction. In 9 patients, spillage of injected indigo carmine dye from the Fallopian tubes was found at repeat laparoscopy. To date, there has been 1 pregnancy. If restoration of fertility is considered, perhaps the ampullary portion of the Fallopian tube should be obstructed rather than the isthmus.

Microsurgical reversal of female sterilization.

PIP: As mentioned recently in an excellent article by Dr. Gomel, intraoperative chromopertubation is an invaluable aid in reconstructive tubal surgery. Unfortunately, the inherent clumsiness and risk of infection associated with the transcervical approach he advocates and the difficulty involved in placing and maintaining a rigid needle tipe in the uterine cavity transfundally make both of these commonly-used techniques less than optimal. Recently we developed a modification of the conventional transfundal method of intraoperative chromopertubation that seems to circumvent these difficulties. In place of an 18-gauge needle, we use an 18- or 20-gauge Teflon intravenous catheter to enter the uterine cavity. The catheter-needle unit is placed through the fundus to a point thought to be in the uterine cavity, and the catheter is gently slid off the needle. If resistance is met, the catheter tip is most likely in the myometrium, and it is repositioned until the catheter does slide off easily. Alternatively, the needle-catheter unit can be placed at full length into the uterus and the needle withdrawn. At this point, the catheter is slowly withdrawn while an attempt is made at dye injection. When injection can be accomplished with minimal resistance, the tip is in the uterine cavity, and the catheter can then be advanced further into this space if desired. Now, with the aid of a lower uterine segment clamp, a length of intravenous extension tubing and a syringe, tubal patency can be fully evaluated. In addition, the catheter can be left in place throughout the repair with a minimal amount of trauma in order that at the end of the case, repeat dye injection can be done to evaluate the integrity of the repair. Also, gentle hydropertubation with an appropriate therapeutic solution can be carried out at this time if desired.^ieng

Macroscopic vasovasostomy.

Ninety-six males underwent vasovasostomy from 1976-1978. Seventy-six of 83 patients who returned for a semen analysis demonstrated sperm in the ejaculate for a 92% surgical patency rate. Thirty-two of 71 eligible patients initiated a pregnancy for a functional success rate of 45%. A statistically significant correlation was found between postoperative motility and pregnancy rate but none between sperm count and pregnancy rate.

PIP: Between 1976 and 1978, 96 patients underwent vasovasostomy at the Stanford University Medical Center's Division of Urology. The patients ranged in age from 22 to 44 at the time of the vasectomy and from 27 to 62 at the time of the reversal procedure. The main reason for the reversal was divorce and remarriage. 57% had an interval of less than 5 years from vasectomy to reversal, over 43% had an interval over 5 years with 11% having an interval over 10 years. The vasovasostomy procedure is described. 76 of the 83 who returned for a semen analysis demonstrated sperm in the ejaculate for a 92% surgical patency rate. 32 of the 71 patients who tried were able to initiate a pregnancy for a functional success rate of 45%. While there was no correlation between postreversal sperm count and pregnancy rate, there was a statistical correlation between sperm motility and pregnancy rate. In addition, the pregnancy rate for men with a less than 10-year interval between vasectomy and reversal was 50% while the rate for those patients with a longer interval was only 11%, a not statistically significant but certainly suggestive fact.

Surgical restoration of vas continuity after vasectomy: further clinical evaluation of a new operation technique.

PIP: 20 unselected former vasectomy patients were subjected to scrotal exploration and vas recanalization operation. Anastomosis was carried out using a large diameter silicone rubber splint; the splint was removed 7 days postoperatively. No complications or side effects were encountered, and there were no patient complaints of discomfort or pain. 92.3% of the men considered satisfactory candidates for recanalization had successful results, and 30.8% of their wives became pregnant. The low fertility rate following successful vas recanalization is not understood. The 2 conditions which were found to be unfavorable for vas recanalization were a vasectomy where a long segment of the vas had been excised or where the vas section had been made very low and involved its convoluted segment.^ieng

Reactions in rabbit Fallopian tube after plastic reconstruction. I. Gross pathology, tubal patency, and pregnancy.

PIP: Rabbit tubal repair surgery was aseptic with Nembutal and ether anesthesia. Both tubes were cut at the uterotubal junction, a .61 mm thick polyethylene splint was inserted, sutured to the myometrium, and the junction sutured. At 2, 6, 10, 16, and 24 weeks the splint was removed through an incision. After a dye test for patency, 1 tube was removed and the rabbit was mated 1 week later. Results were 30% distorted placement of tube, 30% fibrose tubes (especially after 16 weeks), 47% adhesion (particularly after 6 weeks), some infection, and 55% positive dye flow test. 3 out of 7 rabbits delivered, all in those of the 2-week group that had no adhesions. 2 of the pregnancies occurred in rabbits with no dye passage.^ieng

Reactions in the rabbit Fallopian tube after plastic reconstruction. II. Histopathology.

PIP: In this histological study of tubal repair in rabbits, both fallopian tubes were cut at the uterotubal junction, a .61 mm thick polyethylene splint was inserted, sutured to the myometrium, and the junction sutured. At 2, 6, 10, 16, and 24 weeks the splint was removed through an incision. After a dye test for patency, 1 tube was removed and the rabbit mated 1 week later. Histological stains used included hematoxylin and eosin for detail, periodic acid (Schiff) for secretion, and Herovici for collagen. The normally folded epithelium remained flat. There were few mitoses but many basophilic cells and polymorphonuclear leucocytes appeared in the 2- and 6-week groups. Fibrous replacement of muscle seemed to prevent pregnancy, but absence of folded ciliated epithelium permitted pregnancy in 3 rabbits.^ieng