A new FOATIaRVS (Foci-Ovarian endometrioma-Adhesion-Tubal endometriosis-Inflammation-adenomyosis-Recto Vaginal Space) endometriosis classification is proposed to replace the ASRM (American Society Reproductive Medicine) classification. FOATIaRVS is descriptive, complete, precise, simple and easy-to-use. All endometriotic implants are described through the use of a formula. The attribution of coefficients for each endometriotic site is very simple: 0, 1 or 2. A coefficient of 2 is attributed if the lesion is substantial and could cause infertility or pain. The description of the endometriosis covers not only the usual appearance of the implants but also their functional repercussion for tubal and ovarian function. It also includes results of the most recently developed explorations. The formula is clearly of value for providing information on the progression or the regression of each endometriotic site and on the efficacy of the therapy for each location. It has a predictive value and can provide indications for the choice of therapy.
In 30 years, 1,669 patients underwent open microsurgery for tubal diseases. Several techniques like adhesiolysis, reanastomosis, fimbrioplasty, salpingoneostomy, proximal reconstruction, isthmo-ostial anastomosis and reimplantation are described. Results were excellent for patients with a favourable prognosis (1,517 patients) and with very high pregnancy rate: 80% pregnancies with delivery for tubal reversal, 68% for proximal diseases, 75.1% for fimbrioplasty and 55% for salpingoneostomy. Risks of ectopic pregnancy were very low: 1.5% for tubal reversal (because the tubes were healthy), 4% for proximal diseases, 4% for fimbrioplasty and 6.7% for salpingoneostomy. Results were very low for patients with a poor prognosis (152 patients): 10% pregnancies with delivery for distal diseases, less than 20% for proximal diseases and 22% ectopic pregnancies. Open microsurgery can still be helpful in treating tubal infertility: results are better than those obtained with laparoscopic reconstructive surgery and better than those obtained with in vitro fertilization for patients with a favourable prognosis. Patients are only operated one time and can have several pregnancies. Open tubal microsurgery is a minimal invasive surgery and saves costs (it requires a small number of instruments and minimises sutures; patients can return home 4 days after surgery, at the latest). Results on fertility are very favourable.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.