- ATHENS OFFICE MED4WOMAN ATHENS
- VOLOS OFFICE MED4WOMAN VOLOS
Obstetrician-Gynecologist
PhD, University of Athens Medical School
Obstetrician-gynecologist Panagiotis Polyzos practices at the Institute of Life, the IVF Unit of IASO Maternity Hospital.
Laparoscopic surgery can be used for many surgical procedures on the fallopian tubes, such as:
Many of these procedures are conservative and involve reconstruction of the fallopian tubes and ovaries to preserve fertility. These microsurgical techniques are performed to improve fertility, enhance it, and restore it. Comparisons of similar surgical procedures on the fallopian tubes and ovaries show a significant superiority when performed laparoscopically instead of via laparotomy (less blood loss, faster and easier recovery, and reduced cost).
Below, we will analyze some of the most important gynecological laparoscopic procedures performed on the fallopian tubes.
Tubal reanastomosis or tubal reversal:
A surgical method used to reverse tubal ligation, which may be an option for women who, for various reasons, wish to restore their fertility. Tubal ligation is a procedure previously performed to prevent future pregnancies by surgically tying or burning the fallopian tubes, thereby preventing the passage of eggs from the ovaries to the uterus.
The success of this procedure depends on several factors, such as the length and health of the remaining segments of the fallopian tubes that are to be reconnected, the surgeon’s skill, knowledge, and experience, as well as the woman’s age at the time of the reversal procedure. Restoring tubal patency offers a high likelihood (but not a guarantee) of pregnancy, provided that the fallopian tubes are healthy and no other infertility factors are present. Under optimal conditions, the pregnancy rate can reach 75–80%. The probability of success and the time to conception after tubal reanastomosis surgery are influenced by various factors. In most cases, conception occurs within the first year following the procedure.
Tubal anastomosis is a two- to three-hour operation performed under general anesthesia. Typically, laparoscopy is first performed to assess whether the fallopian tubes are suitable for reversal. If conditions are appropriate, a small transverse incision is made just above the pubic hairline. An operating microscope is used to reconnect the tiny ends of the fallopian tube with very fine sutures.
The risks are extremely rare, but as with any surgical procedure, they include anesthesia-related complications, the possibility of bleeding, infection, or injury to surrounding organs. After tubal reversal, the risk of ectopic pregnancy (tubal pregnancy) increases from 1 in 100 to 5 in 100 pregnancies.
FTR reopens your fallopian tubes if they are blocked. It does not always require surgery.
How is it performed?
The gynecologist will not need to make any incisions during FTR. A speculum will be used to keep your vagina open, and then a small plastic tube or catheter will be inserted through your cervix into your uterus. A contrast dye is then injected through the catheter, followed by an X-ray of your uterus and fallopian tubes to identify the exact location of the blockage. Finally, a second, smaller catheter is used to clear the obstruction. Generally, this procedure is performed in a selected number of patients with specific types of tubal blockage.
Risks
There are several risks associated with this procedure. First, because the procedure uses X-ray contrast dye and radiation, potential complications may occur.
Salpingostomy — sometimes called neosalpingostomy or fimbrioplasty — is a procedure in which your gynecologist creates an opening in the blocked fallopian tube. The blocked and swollen tube, known as a hydrosalpinx, is always filled with fluid.
How is it performed?
During the procedure, your gynecologist will open the fallopian tube and remove the blockage, while trying to keep the tube as intact as possible. The incision is left open so the tube can heal naturally.
Unlike salpingostomy, which repairs the blocked tube and leaves it almost intact, salpingectomy removes it during surgery. Your gynecologist may recommend a bilateral salpingectomy, the complete removal of both fallopian tubes, to improve your chances of success with in vitro fertilization.
How is it performed?
There are several ways in which your gynecologist can perform a laparoscopic salpingectomy. One method involves using a pre-tied surgical loop and tightening the knot around the fallopian tube to remove it. Another method is the cauterization and destruction of the blood vessels within the tube.
Your gynecologist may recommend a fimbrioplasty procedure if you have a blockage in the part of the fallopian tube that is closest to the ovary. This procedure opens the blocked tube and preserves the tissue known as fimbriae, allowing your eggs to move through the tube.
How is it performed?
The fimbriae are small finger-like projections at the end of the fallopian tubes that function to capture the egg once it is released from the ovary. Fimbrioplasty is usually performed as part of a salpingostomy. In addition to clearing the blockage in the tube, your gynecologist will essentially reconstruct the fimbriae.
The decision to operate on the fallopian tubes relies on an accurate picture of the damage. Testing usually starts with hysterosalpingography (HSG) or hysterosalpingo-contrast sonography (HyCoSy), which show whether and where there is a blockage. When the findings are unclear or adhesions and endometriosis are suspected, laparoscopy with dye injection gives the most complete picture.
The surgeon does not only check whether the tube is open. They also assess:
Based on these findings, the damage is classified as mild or severe. Mild damage has a good prognosis after surgical repair. With severe damage, the chance of the tube working again is small, and IVF is usually the most effective route.
A fallopian tube can become blocked at different points, and each point has its own solution.
Pinpointing the damage correctly often spares you unnecessary surgery and saves time.
The most common site of an ectopic pregnancy is the fallopian tube. When medication is not appropriate or does not work, laparoscopy is the method of choice. There are two surgical options:
Large studies have shown that, when the other tube is healthy, the chances of a future natural pregnancy are similar with both techniques. If the tube ruptures with internal bleeding, surgery is an emergency.
In recent years it has become clear that many of the most aggressive cancers once considered “ovarian” actually start at the end of the fallopian tube. This has changed practice. For women who have completed their family and are having another gynecologic procedure, such as a hysterectomy, international scientific societies recommend discussing removal of the fallopian tubes at the same time, while preserving the ovaries.
By the same logic, when a woman wants permanent contraception, removing the fallopian tubes is now an alternative to traditional tubal ligation. It offers the same or better contraceptive protection and a possible reduction in cancer risk. The procedure is done laparoscopically and adds very little time. Available studies show no meaningful effect on ovarian function or the age of menopause. However, it is irreversible, so the decision must be final.
A woman who has had her tubes tied and wants another child has two paths. Comparing them helps her choose the one that fits her situation:
With either option, the first pregnancy must be confirmed early by ultrasound because of the increased risk of ectopic pregnancy.
Most tubal procedures are done laparoscopically, and recovery is quick. Discharge from the clinic usually takes place the same day or the next day. Pain at the incisions and in the shoulders for two to three days is expected and is controlled with simple painkillers. Light activities resume within a few days and office work in about a week. If a microsurgical reconnection was done through a small abdominal incision, recovery takes a little longer.
Contact your doctor if you develop a fever, pain that gets stronger instead of easing, vomiting, or redness and discharge at the incisions.
When a distended, fluid-filled fallopian tube is seen on ultrasound, treating it before the embryo transfer significantly improves the chances of implantation. There are three approaches, depending on anatomy and history:
The choice is made on an individual basis, to protect the ovarian reserve and prepare the uterus for the embryo transfer.
It depends on the location and extent of the damage. Mild blockages and adhesions can be repaired. With severe damage, IVF is preferred.
Fluid from a hydrosalpinx flows toward the uterus and cuts the chances of implantation roughly in half. Removing or tying off the tube restores them.
Usually after one or two cycles, according to your surgeon's instructions.
Yes, the risk is higher. In your next pregnancy, an early ultrasound is done.
Yes. In IVF, fertilization takes place in the laboratory and the embryo is transferred directly into the uterus, so the fallopian tubes are not needed.
Hormones are produced by the ovaries, not the fallopian tubes. Available studies show no meaningful effect of salpingectomy on ovarian function or the age of menopause, as long as the procedure is done with care to protect the blood vessels of the ovary.
Usually a few days for everyday activities and about a week to return to office work. Strenuous exercise and heavy lifting resume in two to three weeks.
Yes, especially when the original damage was severe or there is ongoing inflammation. That is why, if pregnancy is not achieved within a reasonable time after surgery, tubal patency is checked again or IVF is considered.
For most laparoscopic tubal procedures, the clinic stay is a few hours or one night. A longer stay is usually needed only after emergency surgery for a ruptured ectopic pregnancy or after microsurgical reconnection through an abdominal incision.
