Cirugía tubárica frente a reproducción asistida

Autores/as

  • Jaime Saavedra Saavedra

DOI:

https://doi.org/10.18597/rcog.649

Palabras clave:

cirugía tubárica, adhesiolisis, fimbrioplastia, hidrosalpinx, reproducción asistida

Resumen

Toda pareja infértil con factor tubo peritoneal comprometido debe ser estudiada en forma completa; esto incluye espermograma, niveles basales de FSH el día tres del ciclo, histerosalpingografía y laparoscopia diagnóstica.

Estos estudios son decisivos para determinar si la pareja se refiere al programa de cirugía tubárica reconstructiva o al programa de técnicas de reproducción asistida.

Las tasas acumulativas de embarazo en adhesiolisis de adherencias laxas (avasculares) están entre un 50 y un 60%; en adherencias extensas (densas y vasculares) es de 0%, por tanto estas pacientes deben ir a técnicas de reproducción asistida (FIV).

En el caso de fimosis tubárica, la fimbrioplastia por microcirugía presenta una tasa de embarazo del 60% frente a un 30% por laparoscopia, por tanto para el manejo de esta patología se recomienda la microcirugía.

Las tasas de embarazo en caso de hidrosalpinx con daño tubárico mínimo y limitado (presencia de pliegues mucosos en la histerosalpingografía y menos de dos centímetros de diámetro) están entre un 28% por microcirugía y un 24% por laparoscopia; en caso de daño tubárico severo se debe realizar FIV.

Las tasas de embarazo clínico después de FIV-TE en pacientes con factor tubárico varían entre un 30.8 y un 12.8%, dependiendo de la edad de la paciente, estas tasas son mejores en mujeres menores de 35 años y bajas en mujeres de 40 años y más.

Cuando se consideran las tasas acumulativas de embarazo después de cuatro ciclos de reproducción asistida frente a salpingoovariolisis, fimbrioplastia y salpingoneostomía, la primera da mejores resultados en todos los frentes. Sin embargo, podría ser un error pronosticar que la cirugía reconstructiva vaya a ser historia pronto. Si la cirugía es exitosa ésta ofrece la posibilidad de concebir en múltiples ciclos y lograr más embarazos en forma consecutiva.

El riesgo de embarazo múltiple es bajo después del tratamiento quirúrgico.

El factor económico también puede pesar en el momento de tomar una decisión.

Los resultados anteriores sugieren que las mujeres jóvenes, con factor tubo peritoneal leve o moderado, son candidatas primarias para la cirugía tubárica reconstructiva, mientras que mujeres mayores de 35 años o aquéllas con enfermedad severa o pelvis congelada se deben dirigir al programa de reproducción asistida.

Biografía del autor/a

Jaime Saavedra Saavedra

Profesor titular, Departamento de Ginecología y Obstetricia, Universidad del Valle; jefe del Servicio de Ginecología y Obstetricia, Universidad del Valle; director Programa de Entrenamiento de Cirugía Endoscópica, Clínica los Andes, Cali, Colombia; director general del Centro de Biomedicina Reproductiva (Fecundar) Cali, Colombia.

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Cómo citar

1.
Saavedra Saavedra J. Cirugía tubárica frente a reproducción asistida. Rev. colomb. obstet. ginecol. [Internet]. 28 de junio de 2002 [citado 18 de abril de 2024];53(2):185-200. Disponible en: https://revista.fecolsog.org/index.php/rcog/article/view/649

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2002-06-28

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