Fertility and adhesions were examined in 41 rabbits in three treatment groups following the construction of microsurgical anastomoses with fibrin glue and by conventional suturing techniques. The three types of treatment were: isthmic anastomoses without resection, ampullary anastomoses, isthmic anastomoses following resection of oviduct segments. There were no significant differences between the two methods of performing the anastomoses in any of the three groups with respect to number of ovulations, number of implantations, nidation index, and pregnancy rate. The extent of the formation of adhesions was also no different between the two types of anastomosis construction. From the functional point of view, fibrin glueing of the tubes can be considered as good as microsurgical suturing. Another study is planned to examine whether this is also true from the morphological viewpoint. It must be remarked that fibrin glueing does not appear to be suitable for anastomoses in which a lumen-adjusting technique is needed or for deep tubocornual or intramural anastomoses.
In a morphological study fibrin-glued tubal anastomoses were compared with classical anastomoses using microsutures. In the isthmic-isthmic anastomoses, whether they were glued or sutured, the opposition of the folds and the continuity of the tubal wall were good. Scanning electron microscope studies of Fallopian tubes subjected to anastomosis using fibrin glue or microsurgical sutures showed a break in the fold structure regardless of the technique used, with formation of polyp-like and tuborous structures in some of the anastomoses in the ampullary region. In one case of an ampullar-ampullar anastomosis with fibrin glue, formation of a fistula was observed and in another case of the same type of anastomosis a hydrosalpinx developed as the consequence of intratubal adhesions and stenosis. In glued anastomoses in particular, intraluminal fibrin deposits were observed. Otherwise our scanning and transmission electron microscope investigations of the region of the anastomoses revealed a normal cell picture with abundant cilia-bearing, structurally unremarkable cells. Fibrin glueing can thus be regarded as a possible alternative to the conventional microsurgical suturing technique for the construction of anastomoses in the isthmic segment of the tube. In the case of wide-lumen ampullary anastomoses, however, the danger of fistula formation, dehiscence, development of intraluminal adhesions and stenosis must be regarded as increased. Fibrin glueing also does not appear to be appropriate for anastomoses requiring approximation of differing luminal widths.
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