[Microsurgery in gynecology--indications, results and limitations].

Results of conventional microsurgery to restore fertilization after previous tubal sterilization are very satisfactory. The number of ectopic pregnancies is equal to that of patients treated using macrosurgical techniques and that of the average population. The limits of surgical restoration of fertility are dictated not by the surgery itself but by factors such as minimum length of the Fallopian tube after sterilization and the fertility potential of the couple (womans age disrupted hormonal function uncertain male fertility). However for some conditions plastic microsurgery is absolutely contraindicated. These include the following: 1. Patients with or following fallopian tuberculosis. 2. Extensive pelvic adhesions. 3. Extensive intratubal adhesions (honeycomb lumen diagnosed by hysterosalpingography). 4. Fibrous rigid tube. 5. Absence of ampoule. 6. Minimum pathology (mild forms of endometriosis few adhesions unilateral pathology). Plastic microsurgical reconstruction is relatively contraindicated for the following: 1. Conditions following unsuccessful plastic tubal surgery. 2. Short Fallopian tubes (less than 3 centimeters long). 3. Increasing age with decreasing fertility particularly after age 38. 4. Tuboperitoneal and other serious fertility disorders. On the other hand microsurgery has been found to be effective in treatment of post-inflammatory tubal sterility endometriosis especially in medium-severe to severe cases and ectopic pregnancy. As an alternative to any microsurgery to restore fertility in-vitro fertilization is currently the method of choice.