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.
Falloposcopy is a diagnostic method that allows visual inspection of the fallopian pipes from inside. Falloposcopy is performed to assess the abnormalities present in the fallopian tubes right from the uterotubal ostium to the fimbrial end. Hysterosalpingogram and laparoscopy are the conventional methods followed to assess the tubal function; however falloposcopy has been the preferred choice in recent times as it provides accurate visual status of the Fallopian tubes. Falloposcopy is highly useful in diagnosing the conditions such as scar tissue formation, adhesions, blockage in the tubes and damage in the inner lining of the tubes. Falloposcopy is not only used as diagnostic tool, but can also repair and help restore the health of the Fallopian tubes. Fallopian tube blockage is a common cause of female infertility and the procedure helps in recanalizing the obstruction.
The procedure involves inserting a thin catheter into the fallopian tubes. The Fallopian pipes are approached through the cervix and uterus. Once the catheter is placed, a tiny fiber optic endoscope is inserted through it. A small digital camera is attached at the end of the scope which allows the visualization of the fallopian tubes on the external monitor. Falloposcopy is generally carried out under local anesthesia or mild intravenous sedation. The ideal time to perform falloposcopy is mid-follicular phase of menstrual cycle as ostium can be evaluated better in the absence of blood and thick endometrial lining. Falloposcopy requires 30-45 minutes to perform. If followed by tubal reconstructive surgery, the time may extend up to 2 hours.
The catheter can be inserted by following two methods namely coaxial system or LEC (linear everting catheter). The coaxial system needs hysteroscope for its uterine passage and also makes use of the thin guide wire over which catheter is inserted. The guide wire is slowly withdrawn and falloposcopy along with camera will be introduced to take the inside images of the Fallopian tubes. LEC method is performed by unrolling the balloon catheter with internal endoscope and there by doing away with hysteroscopy. LEC method is the latest and preferred choice as inserting the falloposcope with LEC technique is easier and allows visual guidance throughout the process. Hence there is less chances of trauma.
There are no major known risks associated with the falloposcopy. However in rare cases, falloposcopy may cause tubal trauma and may also puncture the tubes. Like any other internal investigation, falloposcopy too carries the risk of infection and bleeding. The patient is normally advised to take antibiotics before the procedure to minimize the risk of infection.
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Bibliography / Reference
Collection of Pages - Last revised Date: November 15, 2019