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tubal surgery

A number of operations on the fallopian tubes are possible in an attempt to restore fertility, by restoring the functioning of the tube assuming it is not too badly damaged. If a tube is very stretched and stiff, or the cilia too badly damaged or defunct due to fluid accumulation (hydrosalpinx), then it must sometimes be removed. An operation could also be undertaken on the tubes to reverse previous sterilisation.

Depending on the reason for the intervention, surgical interventions can be carried out via an abdominal operation (laparotomy) or through keyhole surgery (laparoscopy). Many couples may still have to undergo in vitro fertilisation (IVF) subsequently, and in view of increasing success rates with IVF, surgical intervention is these days becoming increasingly selective.

Below you can find a number of different interventions that can be performed on the fallopian tubes. A rough idea will be given of the chances, as far as is known, of pregnancy after the operation, but because this is dependent on many factors, only your doctor will be able to better assess the chances of success for you.

Adhesions
Adhesions are a major reason for surgical intervention. If there are adhesions around the ovaries and tubes, an attempt can be made to prise the adhesions loose in the hope that the tube will then be in a better state to accept and transport an ovum (egg). The chance of pregnancy after this intervention is estimated at approximately 50%.

Blockage on the side of the uterus
In the presence of a blockage in the tube close to the uterus (proximal or corneal side), the affected part of the tube may be cut out and the tube then stitched back onto the uterus. Here too the chance of pregnancy after this intervention is estimated at approximately 50%.

Blockage at the extremity near the ovary (distal end)
If only the extremities of the tubes (fimbriae) are partially blocked, they can sometimes be opened again (fimbriolysis). If they are completely blocked, then this intervention is referred to as salpingostomy. Depending on the extensiveness of this intervention, the chance of pregnancy is estimated at 25%.

Restorative operation following sterilisation
If a woman has been sterilised in the past, then the tubes will have been surgically sealed. The sealed off section can sometimes be removed and the ends stitched together using microsurgery. Whether this is technically possible depends on, amongst other things, the length of the tube that will remain behind after such an operation. In order to assess whether such an operation will be of use, a sperm analysis of your (new) partner will also be undertaken beforehand. The estimated chance of pregnancy is 60-85%.

Removal of a tube
If the tube is so badly damaged that there is no possibility of repair then a decision is sometimes made to remove it (tubectomy). If serious blockages is present on both sides due to a hydrosalpinx, then IVF is the only remaining option. In this case, as a preparation for an IVF treatment, both the damaged tubes are sometimes removed.

risks

The risks depend on the nature of the operation, but are, in principle, the same as with any other type of laparoscopy or laparotomy. The following phenomena can occur after the operation:

  • Nausea or headaches as a result of the anaesthesia.
  • Abdominal pains following the operation, sensitivity and bruising to the abdomen.
  • Pain in the shoulders and abdomen as a result of the carbon dioxide used in a laparoscopy.

An abdominal operation (laparotomy) is a more extensive intervention than diagnostic surgery, with bleeding and bruising and an interrupted healing of the wound being the most serious short-term effects. Recovery after abdominal surgery also takes a little longer (a few days) than with a diagnostic operation (one to a few days).

In the long term, there is also often the slightly greater chance of an ectopic pregnancy as a result of these operations and/or the development of (new) adhesions.

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possible complications

Serious risks include

  • Venous thrombosis or pulmonary embolism
  • Death
  • Return to theatre
  • Trauma to bowel, bladder or ureter

Frequent risks include

  • Infection
  • Bruising
  • Scaring
  • Adhesions
  • Bleeding
  • Urinary frequency / loss of control
  • Anaemia
  • Fatigue

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