The fallopian tubes may be diseased if there have been previous episodes of infection, particularly recurrent episodes of infection. The degree of damage to the fallopian tubes can be mild, moderate or severe. Sometimes, all that is required is to release adhesions around the fallopian tubes and then the fimbrial end of the tube is seen to be healthy and the tube can go on to function normally. However, if the fallopian tube has become closed over at the fimbrial end to form what is called a hydrosalpinx (literally this means fluid inside the fallopian tube) surgery, more than simply dividing adhesions, will be required.
The fimbrial end of the tube will require opening out (salpingostomy). Although this can be achieved using laparoscopic techniques, the tube is very likely to close over again unless the ends of the tube are sutured back in place. My preference is therefore to carry out tubal microsurgery via a laparotomy (incision through the abdomen) for the surgical correction of hydrosalpinges. The fimbrial end of the tube can be viewed in great detail down the operating microscope and opened out along the scar line. After opening out the tube, the ends are sutured back in place using what is known as the ‘Tulip Technique’, which uses tiny sutures which are almost invisible to the naked eye. The key to this type of surgery is careful patient selection.
Women who have more severe damage to the fallopian tubes, resulting in a more major degree of hydrosalpinx formation tend not to do well with tubal microsurgery. There is a poor chance of success and, if a pregnancy is established, it may result in an ectopic pregnancy (this is where the pregnancy lodges in the fallopian tube rather than the uterus). This is a gynaecological emergency. Therefore, for women with more severe damage of the fallopian tubes, I recommend IVF treatment rather than tubal microsurgery.
Medical research has shown that the results of IVF treatment in this group of women are much better if the badly diseased fallopian tubes are first of all removed. This operation is called salpingectomy. If only one tube is removed the operation is unilateral salpingectomy and if both tubes are removed the operation is called bilateral salpingectomy. This procedure can almost always be carried out laparoscopically and is typically fairly straightforward.
The approach to evaluating the efficacy of medical techniques is known as ‘evidence based medical practice’. I am a member of the American Society for Reproductive Medicine (ASRM). This society produces a number of practice committee reports and two of these focus on the surgical treatment of diseased fallopian tubes. The first is ‘The role of tubal reconstructive surgery in the area of assisted reproductive technologies’ and the second is ‘Salpingectomy for hydrosalpingx prior to in-vitro fertilisation’. Patient information can be located on their website www.asrm.org.