Tubal Surgery

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 done in patients undergoing a hysterectomy (removal of the uterus) plus oophorectomy (removal of the ovary).

Salpingectomy is different from salpingostomy, 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 salpingectomy or salpingostomy 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 the ovarian function.

Tubal Cannulation is a procedure devised for the treatment of 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 helps to open the tube.
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 previous ectopic pregnancy following successful tubal surgery.

Laparoscopic treatment of tubal adhesions and fimbrial phimosis is recommended for some patients with 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 the 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 of or damage to the feathery appendages of the tube (fimbria), known as fimbrial phimosis. The adhesions and the fimbrial phimosis can be treated laparoscopically (keyhole surgery).

Reversal of sterilisation

The surgery employs the use of very thin microsuture to carefully put the tubes back together and is considerably more involved than the operation performed for the sterilisation.

The success of the surgery is dependent upon several factors including the length of the fallopian tube remaining after the sterilization, the use of tying, cautery or burning the fallopian tube and the expertise of the surgeon.

What you need to know about tubal surgery

If pregnancy occurs after tubal surgery, there is a high 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.