Tubal Reconstructive Surgery

Tubal reconstructive surgery is performed to reconstruct the fallopian tubes which are obstructed or tied intentionally. This procedure helps in restoring the normal functioning of the fallopian tubes. Fallopian tubes play an important role in the reproduction process. The matured egg released by the ovary travels through the tube and converges with the sperm to facilitate fertilization. The fertilized egg gets implanted in the uterus to form the embryo. Sometimes the tubes may get blocked due to scar tissue caused by a pelvic infection, endometriosis, or pelvic surgery. When there is an obstruction, the egg cannot reach uterus nor can the sperm meet the egg causing infertility. Tubal reconstruction is a surgical method performed to repair the Fallopian tubes and thereby improving the chances of conception.

Tubal reconstructive surgery is also considered by those women who have undergone sterilization via tubal ligation earlier, but would want to reverse it now for personal reasons. Surgical techniques to reconstruct the fallopian tubes are aimed at achieving patency without harming the tubal anatomy. Hence microsurgical technique is the most preferred choice in conducting the tubal reconstructive surgery.

HSG (hysterosalpingogram) test is performed prior to surgery to evaluate the abnormalities inside the fallopian tubes. HSG Test will reveal the presence of blockage in the fallopian tubes.

Laparoscopic procedure is performed with micro instruments; it is minimally invasive, causes fewer traumas and relatively requires less hospital stay. Not all problems can be corrected using laparoscopy; few cases require an elaborate surgical procedure called laparotomy. Laparotomy is a procedure that involves making a large cut on the abdomen. Through Laparotomy, the surgeon can view the organs clearly, remove the blockage and join the healthy parts of the tubes. This procedure is usually adopted in case of reversal tubal ligation. The choice of the procedure depends upon various factors such as severity of the blockage, location of the obstruction and length of the Fallopian tubes.

There are three types of tubal reconstructive surgical techniques followed by the doctors to repair the Fallopian tubes. The technique chosen depends upon the nature of the problem.

Tubal anastomosis: Tubal anastomosis is a surgical procedure that is normally performed to restore the function of fallopian tubes, which have been blocked by a previous sterilization operation. It is also called tubal ligation reversal or reanastomosis. Typically, sterilization procedure would have closed the mid portion of the tube that lies between the uterus and fimbrial end. Tubal anastomosis technique removes the blocked segment of the tube and joins the two remaining open segments to make it patent.

Tubal implantation: Tubal implantation is a surgical technique that is opted when the blockage is detected at the proximal end (where the Fallopian tube and uterus join). In such cases a new opening will be created in the uterus and a healthy portion of the tube will be inserted into the uterine cavity.

Salpingostomy: Salpingostomy is used in case of distal tubal occlusion, an obstruction near fimbrial end or near ovaries. Salpingostomy involves creating an opening into the Fallopian tube surgically. Salpingostomy is also effective for treatment of hydrosalpinges, a condition where fluid builds up in the tubes leading to an occlusion. Through salpingostomy, excess fluid can be drained and tubes can be cleared to allow normal functioning. Sometimes the problem may occur in the fimbrial region, an end portion of the Fallopian tube that is responsible for sweeping the egg into tube. In such cases fimbria is reconstructed through a surgery called fimbrioplasty.

Tubal reconstructive surgery success rates

The degree of success from surgery will depend upon the extent of tubal damage. Surgery works very well, if the adhesions are small and thin. However with dense adhesions the chances of pregnancy become remote. Age is an important factor that is taken into consideration before proceeding with surgery. Women below 35 years of age have fair chances of becoming pregnant within an year of tubal surgery.

Those who fail to conceive through tubal reconstructive surgery, or, are not right candidates for a surgery are advised to chose an alternative method called IVF or other assisted reproductive techniques.

Risks associated with tubal surgery

The biggest risk associated with tubal surgery is the possibility of developing ectopic pregnancy (tubal pregnancy). Tubal pregnancy is a serious issue and may prove fatal to the mother and hence should be removed as early as possible. Other risks include infection, bleeding, trauma to adjoining organs and also the risk associated with anaesthesia.

Artificial insemination

Artificial insemination refers to a procedure that is used to help an infertile woman become pregnant. Artificial insemination is used when traditional fertilization cannot take place. It is recommended for infertility. Artificial insemination is also used when the father's sperm count is low. A prerequisite for the process of artificial insemination is that the fallopian tubes of the woman must be in good condition, free of any disease and blockage.

The process of artificial insemination may be started with a course of fertility medicines that the woman is given so as to stimulate production and maturity of eggs. Close monitoring is done to evaluate hormone levels and any other risk factors. The woman's ovulation cycle is determined by noting the body temperature and vaginal discharge. Ultrasound is also used for determining the time of a woman's ovulation. The artificial insemination process is done with sperms either from the woman's partner or a donor. It is then injected into the woman's cervix, uterus or fallopian tubes. It may be subject to a special treatment called 'washing' which makes it more concentrated for fertilization.

IVF (In Vitro Fertilization) is a popular assisted reproduction technique. The eggs from the woman and the man's sperm are taken and fertilization takes place in a petri dish outside the woman's womb. This fertilized embryo is then implanted in the woman's uterus. GIFT (Gamete Intra Fallopian Transfer) is a variation on this technique wherein the woman's eggs are retrieved and mixed with the man's sperm and immediately placed into the woman's fallopian tubes. ZIFT (Zygote Intra Fallopian Transfer) involves transfer of fertilized egg to the uterus. GIFT and ZIFT involve laparoscopic surgery.