Microsurgery
Surgery on the Fallopian tube can be used to correct damage and distortion caused by infection, inflammation, ectopic pregnancy or congenital abnormality.
This usually means operating on the fallopian tube to divide surrounding adhesions or overcome blockages.
Microsurgical tuboplasty is a procedure designed to attempt to restore normality to previously damaged fallopian tubes. This may involve the releasing of tissues which are stuck together (e.g. the fallopian tube and the ovary), or the opening up of blocked fallopian tubes. It is normally done in order to attempt to restore normal fertility, and is occasionally used where pelvic pain is the main problem. The procedure should be considered a major operation and usually involves an incision in the lower abdomen. The uterus, fallopian tubes, and ovaries are exposed and then the operating microscope is used in order to visualize more carefully the pelvic structures. The fallopian tubes and often the ovary are delicately operated upon so that there appearance and function at the end of the procedure is as close to normal as possible. Minor adhesions can be divided laparoscopically.
Results
The success of microsurgical tuboplasty is directly related to the degree of damage of the fallopian tube prior to the operation. The greater the damage, the less the likelihood of restoring normal function, and the lower the chance of pregnancy. Where the fallopian tube appears almost normal and only its mobility is restricted by adhesions, the operation produces excellent results. Pregnancy rates in the 12 months that follow the operation range from 15-20% for badly damaged fallopian tubes, up to 75% after the division of minor adhesions.
Side effects & Complications
All surgical procedures have the potential for serious complications, in experienced hands they are extremely rare. These include anaesthetic effects such as: sore throat nausea and vomiting which are transient; operation effects such as pain, general muscular discomfort; wound infection and clotting in legs..
Salpingography and Fallopian tube recanalization
Any form of Fallopian tube patency test such as dye studies or salpingography improves the chance of pregnancy in the months that follow. This is probably due to the effect of flushing out intra-tubal debris or thickened mucous plugs. Commonly, if a blockage of the Fallopian tube is diagnosed at the time of tubal catheterisation and selective salpingography, it can be immediately and effectively treated by wire guided re-canalization techniques. When it is possible, this is a far simpler and more cost effective method than Fallopian tube microsurgery.
Ectopic pregnancy
The risk of pregnancy in the fallopian tube is greater after any tubal surgery. The risk is also related to the degree of initial damage to the tube. The greater the damage, the greater the likelihood of subsequent ectopic pregnancy. The risk ranges from approximately 5% in fairly normal fallopian tubes up to 40% in badly damaged fallopian tubes.