Laparoscopic vs. laparotomy tubal recanalization for fertility restoration after tubal sterilization: a retrospective analysis

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Objective To compare the therapeutic effects of laparoscopic recanalization and laparotomy recanalization on tubal patency restoration after tubal sterilization. Methods A retrospective analysis was conducted on the clinical data of 122 patients who underwent tubal sterilization surgery at one tertiary grade A hospital from May 2013 to May 2023 were retrospectively analyzed.. The patients were divided into the laparoscopic group ( n = 61) and the laparotomy group ( n = 61) based on the surgical approach. The recanalization status, clinical indicators, and postoperative pregnancy outcomes were observed and compared between the two groups. Results The laparoscopic group had a higher recanalization rate, shorter postoperative ambulation, first flatus recovery, and hospital stay times, lower 12-hour pain scores, and less intraoperative blood loss (all P < 0.05). It also showed a higher intrauterine pregnancy rate and lower missed abortion and infertility rates ( P < 0.05), with no significant difference in ectopic pregnancy rates ( P > 0.05). Overall pregnancy rate was 66.39%, significantly associated with age (80.0% for ≤35 vs. 50.8% for >35 years, P = 0.001) and post-anastomosis tubal length (0% for <5 cm, 58.62% for 5–8 cm, 100% for >8 cm, P < 0.001). Univariate and multivariate regression identified age at recanalization and reconstructed tubal length as independent predictors ( P < 0.05); other factors showed no significant associations ( P > 0.05). The ROC curve for tubal length had an AUC of 0.8808(95%CI: 0.8227-0.9389), indicating reliable predictive value. Conclusion Laparoscopic recanalization for patients after tubal sterilization is associated with less intraoperative blood loss, faster postoperative recovery, and higher recanalization and intrauterine pregnancy rates compared with open abdominal recanalization. Age and reconstructed tubal length are critical predictors of pregnancy success, highlighting their importance in preoperative assessment and surgical planning.

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