Tubal Surgery (Salpingostomy & Salpingectomy)

Occlusion of the fallopian tube is a common cause of infertility as it prevents the sperm and ovum (egg) meeting, thereby preventing the process of fertilization from occurring.

Fallopian tube occlusion has a wide range of causes including endometriosis, pelvic inflammatory disease, pelvic infection and pelvic adhesions.

A hysterosalpingogram is performed in order to diagnose an occluded fallopian tube. During this procedure, X-rays of the reproductive tract are taken following injection of a radio-opaque solution into the uterus via a catheter placed in the cervix.

In order to correct the occlusion, a salpingostomy may be performed. During a salpingostomy a new opening in the fallopian tubes is physically created by the surgeon, which can facilitate future pregnancy.

IVF can be considered an alternative form of treatment for patients wishing to conceive and who suffer from fallopian tube occlusion by bypassing the need for fertilization to occur within the body. However, some patients wish to conceive naturally or have other reasons for not wishing to undergo IVF (eg. the increased probability of multiple pregnancies (ie. twins/triplets etc.) which increases the risk of miscarriage). Additionally, in hydrosalpinx, a particular form of fallopian tube occlusion in which the distal tube is occluded is associated with the accumulation of excessive fluids in the fallopian tube, and this can reduce the chance of IVF success by around 50%. Thus salpingostomy (recanalization of the fallopian tube) or salpingectomy (removal of the fallopian tube) may be performed prior to beginning IVF treatment. The advantage of salpingostomy relative to salpingectomy is that since the tube is opened up, not removed, future natural pregnancy is possible, which isn’t the case if the fallopian tube is removed as in salpingectomy. However, a disadvantage of salpingostomy relative to salpingectomy is that re-occlusion following salpingostomy may occur in the future.

It is also important to note that in some instances, tubal occlusion can cause pelvic pain and hence surgical intervention is required in order to treat this underlying pain, even in patients in which fertility is not important.

Images taken by Mr. Trehan during two laparoscopic salpingostomies are shown below. Note that upon completion of the operation in both cases a blue dye has been injected into the uterus – observing this blue dye exuding from the fallopian tubes confirms the success of the salpingostomy as it implies that the fallopian tubes have opened up.

  • Case 1 - Before Salpingostomy
  • Case 1 - After Salpingostomy
  • Case 2 - Before Salpingostomy
  • Case 2 - After Salpingostomy

Mr. Trehan performs all benign gynaecological procedures, including tubal surgery via laparoscopic (keyhole) surgery as it is associated with less post-operative pain and complications, a quicker recovery and a far superior cosmetic appearance when compared to laparotomy (open surgery). Mr. Trehan’s patients can be confident that their operation will be completed by keyhole means as Mr. Trehan’s conversion to laparotomy rate is amongst the lowest in the medical literature, as are his major complication rates, reoperation rates and readmission rates. Further, over 90% of Mr Trehan’s patients are able to leave the hospital after just an overnight stay in hospital.