Indication of Laparoscopy in Case of Tubal Infertility at the University Hospital of Brazzaville (Republic of Congo)

Objective: Analyze the determinants of the indication for laparoscopy in case of tubal obstruction on hysterosalpingography at the University Hospital Center of Brazzaville. Methods: Cross-sectional analytical study, conducted from January 1, 2015 to December 31, 2019, in the Obstetrics Gynecology Department of the University Hospital Center of Brazzaville, comparing 108 infertile patients with tubal obstruction to hysterosalpingography confirmed by methylene blue test (MBT-) in laparoscopy and 78 infertile patients with positive methylene blue test (MBT+) invalidating tubal obstruction in laparoscopy. Epi Info 7 software was used for statistical analysis. The p-value was considered significant for a p value < 5%. Results: Tubal obstruction was confirmed (MBT-) in 108 patients among the 186 selected for the study, i.e. 58.1%, and reversed (MBT+) in 78 patients, i.e. 41.9%. Tubal obstruction on laparoscopy was most observed in patients over 30 years old (84.3% vs 70.5%; OR=2.2 [1.1-4.6]; p<0.05), history of abortive endo-uterine maneuver (ORa=26 [17.9-38.9]; p<0.05), ectopic pregnancy (ORa=3.2 [1.4-52.1]; p<0.05), pelvic surgeries such as myomectomy (ORa=4.1 [1.2-18.4]; p<0.05), appendectomy (ORa=28.5 [1.5-54.7]; p<0.05) and salpingectomy (ORa=4.8 [2.3-12.5]; p<0.05) and suffering from chronic pelvic pain (ORa =4.1 [1.1-15.7]; p<0.03). The distal location of the tubal obstruction on HSG (ORa=2.8 [1.5-14.3]; p<0.05) and seropositivity for chlamydia trachomatis (ORa=41.2 [7.2 -234.8]; p<0.05) were most associated with negative MBT. Conclusion: The decision to perform a laparoscopy for tubal obstruction revealed by hysterosalpingography should take into account the determinants thus identified, especially when it comes to proximal tubal obstruction.