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Laparoscopy – Hydrosalpinx
Causes for Hydrosalpinx
The fallopian tubes are a pair of long narrow ducts attached to the uterus (womb) on the left and right side. Each fallopian tube is about 10 cm long leading from the uterus to the ovaries.
Hydrosalpinx is mainly due to pelvic inflammatory disease or endometriosis causing the blockage of the end of a fallopian tube. With the collection of secretions inside the tube causing further distension, hydrosalpinx resulted.
Diagnosis and Effects of Hydrosalpinx
There is no direct effect on health from hydrosalpinx and most women are asymptomatic.
Hysterosalpingogram (HSG) (x-ray) is commonly used in investigating hydrosalpinx. If patients suffer from a severe hydrosalpinx, the doctor may even be able to detect it on ultrasound scan but laparoscopy remains the best way to make an accurate diagnosis.
Hydrosalpinx causes infertility due to the partial or complete loss of function of the fallopian tube. In addition, some studies have shown that the success rate for IVF are reduced if women have a hydrosalpinx as the tubal fluid may contain toxic substances which will flow into the uterine cavity during/after embryo transfer. Hence, there will be lower implantation and pregnancy rates and also a higher miscarriage rate.
Surgical Procedures for Hydrosalpinx
A doctor will insert a laparoscope to check the fallopian tubes for the severity of the hydrosalpinx. Depends on the degree of damage, different types of operations will be performed accordingly: laparoscopic salpingostomy and salpingectomy.
About Salpingostomy
Salpingostomy is a surgical procedure in which a laparoscope is surgically inserted into the abdomen and an incision is made at the end of the tube near the ovaries. The edges of the incision are then folded, leaving the tube opened in order to increase the chance of nature conception. Salpingostomy is a relatively conservative treatment as the tube itself is not removed in this procedure. According to published studies, the natural pregnancy rate after surgery is heavily depended on the degree of tubal damage caused by inflammatory diseases.
Salpingostomy is more suitable and beneficial for patients with mild tubal disease. The efficacy of the operation is low for patients suffering from a severe tubal demage/hydrosalpinx. In addition, the re-opening of the tubes may also increase the risk of having ectopic pregnancy. Some patients experience recurrence of hydrosalpinx after surgery as the scar tissue reforms causing blockage again.
About Salpingectomy
In general, if there is an irreversible damage to the tube(s), the patients will need a treatment that does not involve the tubes to help them get pregnant, such as in vitro fertilization (IVF, test-tube baby). Unfortunately, a severe hydrosalpinx can have adverse effects on IVF.
Therefore, the doctor may recommend the patient to perform a salpingectomy or proximal tubal blocking before the IVF treatment so as to avoid the tubal fluid flowing into the uterine cavity lowering the chance of pregnancy.
According to published studies, salpingectomy is the most effective way of avoiding the tubal fluid flowing into the uterine cavity. However, if the patient has severe adhesions near the tubes, and the anticipated chance of surgical complications is high by performing salpingectomy, the doctor may consider performing proximal tubal blocking. Proximal tubal blocking is a surgery in which a doctor will make a cut over the fallopian tube and disconnect it from the womb to prevent the tubal fluid from flowing into the uterine cavity, but the tube itself is not removed in the procedure. However, women can no longer get pregnant naturally after undergoing either salpingectomy or proximal tubal blocking, especially for those patients who have had surgery on both tubes. In this situation, women will need IVFtreatment if they want to have babies. Therefore, patients also need to consider the expenses and the success rate of IVF.
Risks and Complications for Laparoscopic Salpingostomy and Salpingectomy
Laparoscopy is a minimally invasive and safe surgical procedure. Complications after a laparoscopy are rare, but can include bleeding, infection, anesthetic complications and accidental damage to nearby organs (bowels, bladder, ureters and blood vessels). If a complication does occur, a traditional open surgery might have to be performed. However, the complication rate is rather rare.