The removal of the fallopian tube: indications, laparoscopy and laparotomy, the consequences
Quite often women of young age for one reason or another carried out the removal of one fallopian tube and, more rarely, both. The total number of such patients is from 3 to 12%. Among the many, including doctors, it is believed that the fallopian tubes are the only «guide» for the oocyte, and so its removal in no way can affect overall health.
At the same time, in different research and practical work increasingly draws attention to the fact that the number of women with various disorders of the menstrual cycle and other violations revealed a large number of those who were carried out this surgical treatment.
Indications for salpingectomy
Salpingectomy (or tubectomy) is an operation which is complete removal of the fallopian tubes. It may be single or double sided and conducted in an emergency or in a planned manner. Salpingectomy is shown:
- Ectopic pregnancy involving rupture of the fallopian tubes and intra-abdominal bleeding.
- When undisturbed tubal pregnancy that cannot be resolved conservatively when the diameter of the ovum, more than 30 mm. Conservative methods are used when women wish to preserve the possibility of natural conception and pregnancy in the future. They are pushing the ovum in the ampullar part of or the imposition salpingostomy (messages from the abdominal cavity).
- In cases of bleeding after the unsuccessful meeting of salpingostomy.
- When undisturbed, but repeated ectopic pregnancy in the same fallopian tube.
- In cases the duration of the current, and not amenable to conservative treatment of salpingitis and/or oophoritis (adnexitis), leading to significant changes in the pipe, with the result that it becomes futile in terms of functionality.
- When inflammation purulent character (pyosalpinx).
- In the presence of one — or two-sided hydrosalpinx (accumulation of significant amounts of fluid). Infertility is often the consequence of this disease. The liquid in the pipes is accumulated, usually in connection with chronic periodically escalating inflammatory process in them.
- In cases of planning in vitro fertilization (IVF). The removal of the fallopian tubes before IVF is due to the fact that otherwise there is great risk of its inefficiency. This is due to the possibility of back flow of inflammatory fluids from them into the cavity of the uterus and mechanical «flushing» of the embryo during implantation.
In addition, the fluid of hydrosalpinx containing microorganisms, their decay products and activity, inflammatory components, especially in the period of acute salpingitis in the stage of embryo transfer, have a toxic effect on the endometrium and the embryo.
Even when the implantation of the fertilized egg and the development of pregnancy remains very high risk of spontaneous abortion. Therefore, when a woman has hydrosalpinx of considerable size, the existing more than six months, it is recommended to IVF after removal of the fallopian tubes.
- In the event of significant adhesive process in the pelvis with involvement of the fallopian tubes.
- Hysterectomy conducted in respect of tumors — multiple fibroids, uterine fibroids of considerable size, a malignant tumor of the ovary, body and cervix.
A great help in deciding the choice of treatment and the need for salpingectomy having a diagnostic laparoscopy.
The nature of surgical intervention
Surgical treatment is laparoscopic or laparotomies method. Laparoscopic salpingectomy can be performed in all cases (except for intra-abdominal bleeding) with the appropriate equipment and hold by the surgeon-gynecologist by this method.
The benefits of laparoscopic surgery compared to laparotomy, are small incisions (1.5 cm) and less trauma. In addition, the postoperative period is milder, and the rehabilitation after the removal of the fallopian tubes laparoscopically duration is much shorter.
Ectopic pregnancy, which flows by type of tear is usually accompanied by copious bleeding into the pelvic cavity. Blood loss may be significant, may lead to hemorrhagic shock and other serious negative consequences.
This pregnancy complication requires emergency surgical care. The only surgical approach in this case is salpingectomy laparotomies while conducting intensive infusion-transfusion therapy. Often, such emergency measures can save the lives of women.
The surgery is performed under General anesthesia in several stages:
- Ensuring access. Access the pelvic organs is provided by a cross above the fold (Pfannenstiel) or longitudinal Nizhneserginsky (below the navel) incision of anterior abdominal wall (laparotomy).
- Evacuation in special vials of blood that flows into the abdominal cavity (in the absence of foci of infection), for review by the anesthesiologist of blood transfusion (blood transfusion) during the operation.
- The removal of the uterine appendages in the wound and identifying the source of bleeding.
- Overlaying multiple clips on istericeski Department (at the corner of the uterus) and mesosalpinx (mesentery), and then the bleeding stops.
- The selection and clipping of the pipe.
- The reorganization of the abdominal cavity and its layer-by-layer suturing.
Principles of surgical treatment by laparoscopic method the same, except for the collection of blood in the abdominal cavity and its transfusion to the patient.
For certain indications instead of salpingectomy resection of fallopian tubes, that is, partial (segmental) their removal. This is possible with:
- adhesive process in the pelvis with involvement of the latter, but on a very limited area;
- when developing, but undisturbed ectopic pregnancy (without rupture of the fallopian tube);
- in the presence of a benign tumor masses localized in one of the uterine angles, as well as in cases of technical difficulties of salpingectomy.
Resection can be carried out also in cases of obstruction of the fallopian tubes due to the formation in them post-inflammatory adhesions in a limited area. The question of the possibility and necessity of resection of the solved individually.
See also: laparoscopy of the fallopian tubes
Is it possible to restore the fallopian tube after removal?
Reconstruction (plastic) is only possible when carrying out resection of the fallopian tubes. This is done usually in cases when the woman wants to keep at least a slight chance to get pregnant naturally. Remote same the fallopian tube cannot be recovered.
Complications after surgery
Possible complications after removal of the fallopian tube are no different from other postoperative complications. These are, mainly:
- post-operative bleeding or formation of hematoma in the abdominal cavity, the subcutaneous tissue in case of blood clotting or poor conduct surgeon hemostasis (bleeding control) during surgery;
- nausea and vomiting associated with anesthesia or irritation of the intestine, the latter is more common after laparoscopic surgery in which the abdominal cavity is pumped gas;
- adhesions in the abdominal cavity, which can cause disruption to intestinal obstruction, etc.
All of these complications occur very rarely.
The rehabilitation period
Rehabilitation after removal of fallopian tubes includes a daily dose of antibiotic into a vein before the operation and in the immediate postoperative period for the prevention of inflammatory processes.
The decrease of the degree of formation of adhesions can be done by reducing the morbidity of the operation, careful hemostasis holding, introduction into the abdominal cavity in the end of the operation, the barrier is biocompatible absorbable (resorbable) gels, which are temporarily separated from each other opposite surface of the bodies, as well as early activation of patients, conducting physical therapy, etc.
It is also possible scarce bleeding after removal in the first 2-3 days, especially if the surgery was associated with a rupture of the epididymis or hematocolpos when disturbed ectopic pregnancy. However, this is not a complication since the presence of vaginal bleeding from the genital tract due to reflux of blood in the uterus before and/or during surgery.
Most women in the postoperative period of the menstrual cycle can be restored in the same mode. With its calculation the day of surgery is equivalent to the first day of the last menstrual period.
In some cases, the period after the removal of the fallopian tube may occur 2-3 days, which may be associated with rapid adaptation of reproductive system of body or with short-term hormonal imbalance. Often the duration may be greater than before the operation. If menstrual bleeding is not heavy, it should not cause concern. Otherwise, is scraping of the uterine cavity and is assigned to conventional hemostatic therapy.
Sometimes the menstrual cycle is not restored for 2 months, which is quite acceptable. A longer period indicates a stressful condition of women, but more often it is associated with endocrine dysfunction. Such violations require specifying the reasons for and administration of appropriate sedation therapy hormonal correction.
Where does the egg after the removal of the fallopian tube?
For the fusion of the sperm with the ovum and conception has no special meaning the place of ovulation in the left or right ovary. After ovulation, the egg enters the abdominal cavity where it can be in a viable condition for 2 days, during which she is captured fimbriae pipe. The highlight is the meeting of gametes and the fertilization of the egg.
In the absence of one of the appendages is possible:
- lack of ovulation and the emergence of atletichny follicles (reverse development) due to the hormonal imbalance;
- the death and destruction of the ovum in the abdominal cavity;
- it migrated in the abdominal cavity to the opposite pipe, fimbriae capture and transfer into the uterus.
Of course, the process of capturing eggs fimbriae is easier and faster if ovulation occurs from the opposite side of salpingectomy. In the case of the two-way tubectomy possible only the first two options.
The consequences for the organism
The uterus and its appendages are anatomically and functionally linked by a common innervation, blood supply and lymphatic system. In addition, these hormonal organs associated with the Breasts, but through the principle of inverse and direct relationships to the entire neuroendocrine system via the axis hypothalamus-pituitary gland. Violations in the past lead to changes in thyroid function and adrenal glands.
Not always, but quite often, in the case of total or partial removal of one of the sections of the internal reproductive organs occur, anatomical and physiological, and overt or subtle, the appropriate hormone, and thus functional changes throughout the system.
A significant percentage of women after one or, more often, bilateral salpingectomy complains of periodical vertigo and headache, instability of the psyche, in particular the excessive and unreasonable irritability, discomfort and pain in the heart area, heart palpitations, excessive sweating, feeling bouts of flushing.
These symptoms occur in 42% of patients and are transient in nature: they occur mainly at a delay of menstruation or before its onset. About 35% have undergone tubectomy women after 2 or 3 months suffer from various disorders of the menstrual cycle. The result of performing an ultrasound examination in 28% of the determined enlarged ovary from operations and its sclerotic changes, which is associated with impaired blood flow and lymph, as well as cystic formations in the result of increasing the degree of follicular atresia.
The majority of women disrupted menstrual cycles alternate with right two-phase cycles. There are also cases of reduced luteal function of the body and the follicles and absence of ovulation, but small percent of patients.
Some of the operated women soon after the removal of the fallopian tube revealed engorgement (6%), pain and diffuse enlargement of the breast (15%), thyroid enlargement without disorder of its functions (26%) and excessive hair growth, formation of striae, weight gain. Such objective symptoms are a manifestation of disturbances in the hypothalamic-pituitary system.
All of these violations occur more frequently and are more pronounced in women undergoing bilateral tubectomy.
When you can get pregnant?
Percentage of the possibility of pregnancy after tubectomy does not depend on the operating technique used (laparoscopic or laparotomies method) and an average of 56-61% .
To plan pregnancy within six months after the operation. However, it is better if it to implement in 1-2 years, taking oral contraceptives by appointment gynecologist. During this time, the function of the neuroendocrine system is fully restored and stabiliziruemost.
After salpingectomy the risk of ectopic pregnancy increases by almost 10 times, 40% of women of generative ability of the ovaries decreases, and in 42% developing infertility. In vitro fertilization for women undergoing tubectomy, especially bilateral, is the only possibility of pregnancy.