Strength and Limitations
As far as we are aware of is this the first study comparing the
cumulative livebirth rate of women with bilateral severe hydrosalpinges
between salpingectomy and neosalpingostomy. Well defined in- and
exclusion criteria and consecutive inclusion of women reduced the risk
on selection bias and reduced the effect of potential confounders. Given
our strict selection criteria, caution needs to be taken by generalizing
our data to other populations. The strength of our study is that we
registered the fertility outcome during a very long follow-up period in
a structured way. Another strength is that the severity of tubal lesions
was scored by two surgeons using validated scoring systems and we
included only women with severe hydrosalpinges based on this
classification, excluding any confounding factors due to differences in
severity score. Attention was paid
to prevent any damage of the fallopian tubes or blood supply to the
ovaries. It is unclear whether the carefully performed surgery by our
skilled chief physicians played a role. Additionally, we also used cox
regression analyses to adjust for potential confounders.
However, our study had also some limitations.
First, we did not obtain the
ethical approval number at the onset of our study for the reason that
our hospital had not set up the Ethics Committee at that time, and we
made a supplementary application and obtained the ethical approval later
when it was established. Second, due to the fact that type of surgery
was based on the shared medical decision-making approach, the risk on
selection bias is inevitable, although this was limited when we only
included women with confirmed severe bilateral hydrosalpinges during
surgery, this was in line with that no major differences in baseline
characteristics were found between the two groups. In the long follow-up
period, the number of cases lost to follow-up was limited. The primary
outcome could be assessed in 47(84%) in the salpingectomy and 47(81%)
in the neosalpingostomy group. Future studies of sufficient sample size
should be carried out to confirm our data and discover more predictors
for successful live birth.