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.