Salpingectomy – Salpingostomy
Salpingectomy refers to the surgical removal of a diseased fallopian tube. The procedure was first performed in women with a bleeding tubal pregnancy (ectopic pregnancy). Other indications for a salpingectomy include fluid-filled blocked tubes (known as hydrosalpinges). Salpingectomy is performed on patients undergoing a hysterectomy (removal of the uterus) plus oophorectomy (removal of the ovary).
Salpingostomy is a procedure where an opening is made into the tube to remove its contents but the tube itself is not removed. The margins of the tubal incision are not sutured. It is still not clear which of the two techniques has most advantages and the least disadvantages for future pregnancy. Nowadays, with the progress in the field of minimally invasive surgery, the laparoscopic approach for salpingectomies or salpingostomies has become standard practice.
When performing a salpingectomy, it is important to bear in mind the close relationship between the tube and the blood supply to the ovary to avoid any potential damages to ovarian function.
This is a procedure devised for the treatment of cornual occlusion or proximal tubal occlusion in women with tubal factor infertility. A tiny wire is placed through the cervix and uterus and into the tube either under x-ray guidance or via a hysteroscope. Tubal cannulation gently opens the tube and may relieve an obstruction in the cornual area. Laparoscopy can be performed at the same of the hysteroscopy to ensure that the tubes are not perforated with the wire and also to inject some dye through the uterus into the tubes to verify that they are open.
Hysteroscopic tubal cannulation allows visualisation of the entire uterine cavity which may be useful in the diagnosis and treating other coexisting problems at the same time as cannulation. In 2004 the National Institute for Health and Clinical Excellence (NICE) guideline for the management of infertility has recommended tubal cannulation as a treatment option in cases of proximal tubal occlusion.
In carefully selected cases, tubal surgery has comparable success rates with IVF with the advantage of avoiding the risks of ovarian hyperstimulation syndrome and multiple pregnancies. Subsequent spontaneous pregnancies after one intervention is also a realistic possibility. IVF may be considered as the first treatment option in older women (>37 years), in the presence of other factors contributing to the couple ‘s subfertility and when either there has been no pregnancy or a previous ectopic pregnancy following successful tubal surgery.
Laparoscopic treatment of tubal adhesions and fimbrial phimosis
Some patients with an otherwise normal fertility evaluation can have subtle adhesions over the fallopian tubes and ovaries. These adhesions appear like cobwebs (or cling-film) over the surface of these organs and can prevent the release of an egg during ovulation, prevent the tubes from picking-up the eggs and limit the motility of the tubes. Injury to the distal end of the tubes may also result in loss or damage to the feathery appendages of the tube (fimbria), known as fimbrial phimosis. Patients at high risk for these problems include those who have had intrauterine devices for a long time, those with a history of pelvic inflammatory disease (PID), appendicitis or a ruptured ovarian cyst. Adhesions and the fimbrial phimosis can be treated laparoscopically (keyhole surgery).
Reversal of sterilisation
Tubal occlusion is a common mean of birth control. The operation to reverse this permanent form of contraception is known as reversal of sterilisation or microsurgical tubal reanastomosis. The surgery employs the use of very thin microsutures to carefully put the tubes back together and is considerably more involved than the operation performed for the sterilisation.
Reversal of tubal sterilisation can be performed by laparoscopy or through a mini-laparotomy incision. If the procedure is completed by laparoscopy patients are allowed home the same day and their recovery time is much quicker as compared to mini-laparotomy which may require up to two days of hospital stay and may restrict daily activities for a period up to four weeks.
The success of surgery is dependent upon several factors including the length of the fallopian tube remaining after the sterilization, the technique employed (type of sutures, use of cautery) and the expertise of the surgeon.
What you need to know about tubal surgery
If pregnancy occurs after tubal surgery there is an increased risk for ectopic pregnancy (i.e. tubal pregnancy). An early pregnancy test and ultrasound scan can help confirm the site of pregnancy. Should there be uncertainty about the location of the pregnancy close monitoring in a dedicated clinic with ultrasound facilities is recommended.
Mr Nardo is fully trained in reproductive medicine and surgery, and is one of the few skilled surgeons able to perform every kind of tubal surgery including the reversal of sterilisation by laparoscopy as a day case procedure.