Tubectomy (removal of the fallopian tubes): indications, methods, consequences and recovery
Surgical treatment of pathology of the fallopian tubes is one of the most frequent surgical interventions in gynecological departments. Their number is increasing, partly associated with the development of in vitro fertilization.
Tubectomy (salpingectomy) is a surgical operation to remove the fallopian or uterine tube. Depending on the method of access to the uterus with appendages, the operation is executed laparotomies through the incision of the anterior abdominal wall, or using endoscopic equipment and techniques (laparoscopically).
The reason for the removal of the fallopian tubes
Surgical treatment can be performed in an emergency or in a planned manner. The evidence for this is anatomical or functional failure of one or two fallopian tubes, which represents a threat to the life or health of the woman or becomes a cause of infertility. Most often the removal of the fallopian tube in ectopic pregnancy.
The main causes of tubectomy:
- Violation of tubal pregnancy by type of tubal rupture accompanied by intra-abdominal bleeding, often profuse and life threatening.
- The threat of rupture with ectopic pregnancy and the presence of hematocolpos.
- Undisturbed ectopic pregnancy, which resolution is impossible by conservative surgical treatment. Last shown when the size of a fertilized egg less than 30 mm, and the woman’s desire to keep the probability of natural fertilization and pregnancy in the future. Conservative operation is to push the ovum in the ampullar Department of the fallopian tube or removal of the ovum through the incision with the subsequent plasty.
- Undisturbed, but the repeat ectopic pregnancy on the same side.
- Chronic inflammation — purulent salpingitis, hydrosalpinx, oophoritis. The removal of the fallopian tubes inflammation is quite frequent operation, the number of which in recent times continues to grow. This is due to the increase in the number of inflammatory diseases is mainly due to the early onset of sexual activity, infections that are sexually transmitted, and also due to not decreasing the number of medical and instrumental (especially) abortion.
- Pregnancy planning through the use of reproductive technologies in infertility due to the presence of one — or two-sided hydrosalpinx salpingitis or chronic, not amenable to treatment by a conservative. The need for tubectomy before IVF is associated with a high risk of inefficiency of the procedure, due to the toxic effects of inflammatory tubal fluid to the uterine lining and fertilized egg, and a possibility of mechanical washing of the latter (during implantation) due to the reverse current of the liquid, especially in the period of acute salpingitis.
- Torsion legs ovarian cyst, ruptured ovarian cyst.
- A marked adhesive process in the pelvis with involvement of the appendages.
- Hysterectomy about tubo-ovarian education, multiple fibroids, large fibroids, or malignant tumors of the uterus, external endometriosis, cancer of the colon.
- The reason for the removal of the pipe to the right can be gangrenous and perforated appendicitis or Crohn’s disease with the development of peritonitis and involvement in the inflammatory process appendages. The reason for the removal of the appendages on the left are often Crohn’s disease or any other disease of the sigmoid colon.
- Bleeding after failed salpingostomy.
The effects of tubectomy for the body
Among the many gynecologists to this day there is a routine notion that the fallopian tube is functionally serve only for the passage of the egg, and any surgical procedures they are to the body as a whole indifferent.
Scientific observation and statistical testing allowed us to understand why there is menstruation and what happens in the body after unilateral or bilateral tubectomy. Uterus – fallopian tubes – ovaries — it is a single system having a single circulatory, lymphatic and nervous system, and hormonal regulation of their function. It is part of the axis «hypothalamus – pituitary — ovary» is associated with the other endocrine glands and the cerebral cortex.
Noted that 40-45% of women undergoing unilateral tubectomy, after a while you might see signs of dysfunction of the entire neuroendocrine system is a relatively rapid increase in body mass, development of hypertrichosis, enlargement, and dysfunction of the thyroid gland (15%), the increase in volume and engorgement (6%), accompanied by their tenderness.
Operated women often complain of volatility of blood pressure (increases) and headaches, dizziness, feeling of hot flushes to the face and chest, increased irritability, mental instability, sweating and a feeling of the heartbeat. These symptoms appear especially at long delay period or prior to their onset, etc. in 25% of possible ectopic pregnancy.
In addition, 30-35% 2-3 months after surgery is a violation of menstrual function, manifested in the alternation of proper biphasic cycles with their violation, and a lesser number of operated — resistant anovulation or reduced function of the follicle and yellow body.
Instrumental examination revealed signs of violation of blood and lymph circulation in the area of operations, increased degree of follicular atresia and the increase of the ovary from the side remote of the pipe.
Bilateral tubectomy is characterized by a higher degree of severity of the listed symptoms, a higher percentage of their frequency (2-3 times) and earlier onset of menopausal period.
Is it possible to get pregnant after removing fallopian tubes?
IVF after removal of the fallopian tubes is the only way to get pregnant. In cases of unilateral destruction of the possibility of natural fertilization and pregnancy rates remains on average only 57% of operated women.
Methods and operation
Technically, the operations differ only in the way of access.
Can be Nizhneserginsky section (along the median line of the abdomen from the umbilicus or above to the symphysis) or transverse incision in the skin crease 2-3 cm above symphysis (Pfannenstiel incision).
First look laparotomy is the most simple and is used in cases the need to stop excessive bleeding, and those with extensive commissural processes in the small pelvis, or bulk of tubo-ovarian malignant neoplasm of the diffuse pelvioperitonit.
The second method is less traumatic and allows to impose a cosmetic seam of skin and requires shorter rehabilitation period. It is used in the same cases, but characterized by a lower urgency and requiring a smaller volume of operative intervention, and in the absence of the possibility of carrying out the operation laparoscopically (no equipment or specialist familiar with the technique).
Can only be carried out in the absence of the above factors. It consists in the introduction through the abdominal wall a special needle (the Veress needle) and the creation of a pneumoperitoneum (gas injection into the abdominal cavity) under the control of the pressure. After this introduced additional trocars-tubes, designed for endoscope and manipulator.
Laparoscopic tubectomy allows to reduce the degree of trauma surgery, due to the increase in the size of organs and vessels, displayed on the monitor screen with a camcorder. Rehabilitation after laparoscopic surgery characteristic short and easy course.
Any type of tubectomies performed under General combined endotracheal anesthesia. In the absence of bleeding are optimal regional anesthesia (epidural or spinal) with sedation, or a combination endotracheal anesthesia with regional anesthesia. Laparotomies operation is carried out only under endotracheal anesthesia.
The operations on the direct removal of pipe is to overlay multiple clips on her fallopian Department and the mesentery from the vials up to the uterine angle, after which the bleeding, if any, shall be terminated immediately. Then the fallopian tube is separated above the clips and remove. If necessary before removal is the dissection of adhesions.
How long is the surgery?
In the absence of the expressed adhesive process, a large amount of blood in the abdominal cavity, pelvioperitonit and other complicating circumstances, the duration of surgery is an average of 35-40 minutes.
The rehabilitation period
Recovery after removal of the fallopian tube is in the early physical activity, but without exercise. It is not recommended to lift anything heavy. In the immediate postoperative period for several days, food should be easily digestible without significant fiber content. Otherwise, a special diet is not required. With significant blood loss are recommended foods that contain vitamins, macro — and micronutrients.
The treatment after tubectomy includes antibiotics, anti-inflammatory and vitamin preparations in the next postoperative days. In order to reduce the likelihood of inflammatory processes and the formation of adhesions is also physical therapy in the form of iono — and phonophoresis, laser and magnetic therapy, etc.
When you can get pregnant?
Planning pregnancy it is advisable to only six months, but the optimum period of 1 year. In order to prevent more early pregnancy it is possible to use combined oral contraceptives.
If necessary, in the case of the presence of symptoms of neuroendocrine disturbances, used hormone replacement therapy for one of the schemes, which is determined by the attending physician.