The fallopian tubes are the place where sperm meet to fertilise eggs; a vital part of conception. Pregnancy is unlikely to ensue if the tubes prevent sperm accessing the released egg. Damage to the fallopian tubes (tubal pathology) accounts for about 25% of all infertility.
WHAT IS RECONSTRUCTIVE TUBAL SURGERY?
Reconstructive tubal surgery repairs the damage to the fallopian tube(s) to re-establish patency and facilitate pregnancy.
WHO IS IT FOR?
About 1 in 4 cases of damaged fallopian tube derive a beneficial outcome from tubal surgery. It is imperative that cases are selected appropriately. Reconstructive tubal surgery is indicated for women with:
- Peri-tubal adhesions – peri-tubal adhesions can result from pelvic inflammatory disease- the commonest cause of tubal pathology. Other conditions that cause inflammatory reactions in the pelvis include endometriosis, appendicitis and pelvic surgery.
- Partial tubal block – partial tubal block can result from any of the causes highlighted above and either prevent sperm accessing eggs, or prevent the fertilised egg making its way back to the womb. In the latter case, the fertilised egg could implant into the tube, resulting in an ectopic pregnancy.
- Complete tubal block – these blocks typically occur at the beginning of the tube where it leaves the womb or at its end close to the ovary.
- Hydrosalpinx – this refers to fluid accumulation within the tube due to partial or complete block. Long-standing fluid accumulation within the tube typically causes damage to the inner lining, so even opening up the tube subsequently may not correct its function.
WHAT INVESTIGATIONS ARE REQUIRED BEFORE TUBAL SURGERY?
We typically undertake the following screening procedures before embarking on tubal surgery:
- Ovarian reserve testing
- Ovulation screen Pelvic ultrasound
- Tubal patency testing
- Semen analysis
WHAT TYPES OF TUBAL SURGERY DO WE PERFORM?
We typically perform outpatient tubal surgery by laparoscopic keyhole surgery. We undertake the following procedures:
- Peri-tubal Adhesiolysis – we divide adhesions impairing the function of the tube to restore their function. This form of tubal surgery is highly successful.
- Salpingostomy – re-establishing patency of completely blocked tubes is most suitable for tubes with distal block. This type of tubal surgery has moderate chance of success in well-selected cases.
- Tubal Cannulation – passing a cannula through the womb into the tube to re-establish its patency is suitable for tubes that are completely blocked at their proximal ends. This type of surgery has moderate chance of success in well-selected cases.
- Salpingectomy – it is sometimes better to remove tubes that contain fluid and are too badly damaged. Leaving them in place could reduce chances of pregnancy by about 50%.
WHAT CAN GO WRONG?
Like every surgical procedure, tubal surgery carries risks that patients need to be aware of. More information can be found under risks of laparoscopic surgery.