Restoration of tubal

patency
Rachana Gangadhar
89
Tuboplasty

• Tuboplasty is the name given to finer surgery on

the tubes to restore the anatomy and physiology as
far as practicable.
Tubal factors
Tubal factors for infertility are corrected only by
surgery
• Peritubal adhesions- correction done by salpingo-
ovariolysis
• Proximal tubal block- salpingography under
fluoroscopy (to remove any block due to mucus
plugging) OR proximal tubal cannulation
• Distal tubal block - fimbrioplasty
• Mid tubal block - Reversal of tubal ligation
Methods of tubal surgery
• Adhesiolysis - Separation or division of adhesions
• Fimbrioplasty - separation of the fimbrial adhesions
• Salpingostomy- creates a new opening in a
completely occluded tube
• Tubotubal anastomosis- segement of the diseased
tube following tubectomy operation is resected and
end to end anastomosis is done
• Tubocornual anastomosis - when there is a cornual
block,the remaining healthy tube is anastomosed to
the patienfs interstitial part of the tube.
Considerations for tubal surgery
• Tubal surgery may be considered in young women
after previous tubal sterilization or in women with
mild disease at the distal tubal segment.
• Preoperative assessment and planning for surgery
has to be done by HSG or laparoscopy
• Prior counselling of the couple about the hazards of
surgery and prospect of future prrgnancy should be
done
• In tubercular salpingitis , surgery is to be witheld.
Following anti tubercular therapy ,IVF maybe
employed when endometrium becomes free from
the disease.
• IVF is considered as the best treatment option for
any complicated tubal occlusive disease.
Factors to improve the success
rate of tuboplasty
• Gentle handling of tissues
• Use of magnification
• Avoid mopping or rubbing of the tissues but using
continous suction or irrigation to remove the clots
• Prevent dessication of tissues
• Hemostasis secured by cautery or laser
• Use of fine suture material (vicryl,proline)
• Use of heparin solution for hydroflotation to
prevent post operative adhesions
Microsurgical techniques give better result due to
• minimal tissue handling and damage
• Perfect hemostasis
• Minimal adhesion formation

• Laparoscopy surgery gives the best result.

Advantages of tuboplasty
• One time therapy
• Low cost compared to IVF
• Saves time of repeated visits to IVF centre
• Subsequent spontaneous pregnancies possible if
surgery is successful
Adjuvant therapy

Adjuvant procedures to improve the result of tubal

surgery include
• Prophylactic antibiotics
• Use of adhesion prevention devices(intercede,
seprafilm)
• Postoperative hydrotubation
Hydrotubation
• It is a procedure to flush the tubal lumen by
medicated fluids passed transcervically through a
cannula.
• The fluid contains antibiotics and hydrocortisone
( Gentamicin 80mg and dexamethasone 4mg in
10ml distilled water)
• It should be done in postmenstrual phase.
Risks of tubal surgery
• Anaesthetic complications
• Post operative wound infection
• Subsequent ectopic pregnancy
Factors for poor outcome
following tuboplasty
• Dense pelvic adhesions
• Loss of fimbriae
• Bilateral hydrosalpinx>3cm
• Length of reconstructed tube <4cm
• Reversal done after 5 years of sterilization
operation
• Presence of other factors for infertility
Results of tuboplasty
The result depends upon the nature of pathology,
type of surgery and techniques employed(
macro/micro surgery)
• Overall pregnancy rate (following laparoscopy) is as
follows
• Salpingo-ovariolysis 65%
• Fimbrioplasty 32%
• Tubo tubal anastomosis 75%
• Tubocorunal anastomosis 55%
Thank you
RESTORATION OF TUBAL
PATENCY
METHODS OF TUBAL SURGERY

MEDIAL END TUBAL BLOCKAGE

• TUBAL CANNULATION
• BALLOON TUBOPLASTY
• TUBOPLASTY

LATERAL END BLOCKAGE

• FIMBRIOPLASTY
• SALPINGOSTOMY
 TUBAL CANNULATION

• While doing hysteroscopy , pass a thin guidewire

through channel upto the cornua of the tube so that
if there is any mucous plug debris causing obstrution
or spasm it will be relieved
• Restores patency in 75% cases and pregnancy rate of
40% is reported if tubal blockage is due to flimsy
adhesions
 BALLOON TUBOPLASTY

• Balloon tuboplasty, also known as balloon

dilation or tuboplasty, is a minimally invasive
procedure used to treat certain types of
blocked or narrowed Fallopian tubes.
• During the procedure, a small balloon is
inserted into the affected tube and inflated to
widen the passage, allowing for improved
drainage or function
 FIMBRIOPLASTY
• Done in cases where fimbrial end is blocked
• step 1 : with the help of a Grasper we hold the
wayright fimbrial end of the fallopian tube.
• Step 2 : with the help of sharp scissor a small
nick is made
• Step 3: Dilate till the ampullary part with the
help of scissors
• Step 4 : Laparoscopic chromopertubation is
done. Spillage of the blue dye can be visualised
out of the right fimbrial end of the tube.
 SALPINGOSTOMY
• It involves creating a small incision in the
fallopian tube to remove any blockages, fluid,
or tissue that may be causing obstruction or
damage conditions such as hydrosalpinx (fluid-
filled fallopian tube) or distal tubal occlusion
(blockage at the end of the tube)
THANK YOU