Suturing versus flowering technique of Bruhat after fimbrioplasty for endometriosis-related infertility

The objective of this study is to compare the effectiveness of two surgical techniques (suturing versus flowering of Bruhat) after fimbrioplasty for treatment of distal tubal pathology in infertile women with endometriosis. This is a historical cohort study with 12 months of follow-up comparing pregnancy rates achieved spontaneously or after controlled ovarian hyperstimulation (COS) with intrauterine insemination (IUI) in infertile women with endometriosis who underwent laparoscopic fimbrioplasty. A total of 154 patients with endometriosis-related infertility (pelvic inflammatory disease was excluded by absent history and negative Chlamydia trachomatis serology) had fimbrioplasty using salpingostomy procedure for treatment of distal tubal pathology. The edges of the fimbrial ostium were everted using either the flowering technique of Bruhat or 6-0 Vicryl sutures (intracorporeal knot) using microsurgical techniques. Forty-six patients had flowering (group 1) and 108 had suturing (group 2) technique, followed by timed intercourse and/or ovarian hyperstimulation with insemination (COS-IUI) with follow-up until pregnancy or at least 12 months. There was no significant difference in patients' characteristics (age, infertility duration, and endometriosis stage) between the two groups. The pregnancy rate per cycle or per patient and cumulative pregnancy rates were not significantly different between the two groups. There appears to be no advantage of the suturing technique over flowering after salpingostomy for fimbrioplasty. The latter method is easier to learn and requires less operative time to perform.