Tubal Reversal By Salpingostomy
Posted On: Tuesday, December 4th, 2007
Tubal Reversal Procedures
There are 3 types of tubal reversal procedures:
- anastomosis
- implantation
- salpingostomy – (this blog topic)
Salpingostomy Definitions
Salpingostomy is creating an opening in the fallopian tube. It is also called neosalpingostomy, which more clearly indicates the creation of a new opening in the tube. Salpingostomy is the appropriate tubal reversal procedure when the end closest to the ovary is closed and the fallopian tube has not been divided into separate segments. This is what results from a fimbriectomy tubal ligation. It can be seen also when a fallopian tube has become closed as a result of infection (salpingitis).
How I Perform Ampullary Salpingostomy
Salpingostomy involves creating an opening in the end of the fallopian tube with a microsurgical needle electrode. The opening is enlarged and gently folded back so that the internal lining extends over the opened end of the tube. The internal lining is covered with cilia, the hairline projections that beat in coordinated waves. They help capture an egg as it is released from the ovary just as the fimbrial end of the tube does normally. Sutures are placed around the end of the tube that has been folded back. The sutures are hidden underneath the folded-back tubal end. When ampullary salpingostomy is completed, the tubal end looks similar to a normal fallopian tube, provided there is a sufficient ampullary length of tube remaining to fold back.
Types of Salpingostomy
The type of salpingostomy is specified according to the tubal segment that has been opened. This will depend on how much of the fallopian tube was removed during a fimbriectomy. The illustration above shows an ampullary salpingostomy. Salpingostomy at the ampullary, infudibular, or fimbrial tubal segments can result in good success rates. If a large amount of tube has been removed and only the isthmic segment remains, salpingostomy is unlikely to result in pregnancy.
Comment About Salpingostomy
The success of salpingostomy for fimbriectomy tubal reversal depends upon having an adequate length of ampullary segment of the fallopian tube. The length of the remaining ampullary tubal segment can be determined from a hysterosalpingogram (HSG) or from diagnostic laparoscopy. I recommend having an HSG or choosing the screening laparoscopy option when tubal ligation has been performed by fimbriectomy. An HSG can be ordered by the patient’s local doctor and the x-ray films sent to me for examination prior to scheduling tubal reversal surgery. Alternatively, patients can omit having an HSG and schedule their reversal surgery to start with screening laparoscopy. This will show if ampullary salpingostomy will be effective. If so, the tubal reversal procedure will be performed at the same time while the patient is under anesthesia.
Message Board discussion about Microsurgical Salpingostomy
December 19th, 2009 at 1:00 am
I had this procedure done (fimbrectomy) and my tube lengths are both 3 cm. Is this considered an adequate length of ampullary segment to result in pregnancy?
December 19th, 2009 at 1:51 am
Tammy
We generally like for a patient to have 5 cm in tubal length for a reasonable expectation of pregnancy after a fimbrectomy reversal. You should send us your operative report for review.
December 21st, 2009 at 11:09 am
I have had this procedure done in March 2009. I have only one tube at 5cm. As of today, we have had no luck conceiving. I do not regret this surgery because one reason we decided to get it done was because of the bad side effects from my tubal ligation. Since having my tubal reversal, I can say that life is much better. My husband and I were blessed with four children. If God blesses us unexpectedly, we would be ecstatic. Good luck to all who have embarked on these journey.
November 27th, 2010 at 2:34 pm
My tubes have been tied about six years and my friend and I want a child but I cant have anymore kids. How can I get my tubes untied without paying so much money?
November 27th, 2010 at 5:21 pm
Martha
We do have a pre-payment plan for tubal reversal. Unfortunately Medicaid and private insurance will not pay for tubal reversal. You will find that our center is very affordable compared to other tubal reversal providers.
October 7th, 2011 at 7:13 pm
I think I left a message under a different topic on this page but if not then here it goes again. I lost my daughter to SIDS at 4 months of age last year. I had my tubes tied and went in for a reversal. I was given a 50- 80% chance before the surgery. After the surgery, the doctor said that I had a fimbriectomy, which he said was not indicated on the report. He gave me the devastating news that my chances are now 20%at best. I have been so depressed over this because I would have done invetro and spent the money there instead of doing a reversal that I didn’t know would have low success rate. Below is what the report he gave me reads:
On entering the pelvic cavity, the patient had just distal fimbria, but no tube involved in the scattered fimbrial elements, but the patient had approx 5-7cm of proximal tube and neosalpingostomy was done on both sides and it was tied back meticulously. So the tube did readily spill indigo carmine dye without any leakage. The ovary was placed closer to the each tube.
Is there a chance that I can still become pregnant with this procedure that was done? I’m so down because I would have spent the 8,000 on IVF had I known that my chances would only be 5-20%. I’m 37 and have a 6 year old son and never in a million years would I have ever expected my baby girl to die. This is a wonderful site and Im so glad to see response times like your team does. If you can help me understand that I have a decent chance of pregnancy without IVF,that in itself would be a miracle to me. Thank you so much.
October 7th, 2011 at 10:02 pm
Angie
It sounds like you have been given all the correct information and are looking for reassurance. Fimbriectomy is reversible, pregnancy is possible, and the pregnancy success rates range from 15-40% with that type of reversal. In comparison IVF is approximately 35-40% successful for each chance. This testimonial was submitted to us by one of our patients who had blocked tubes from a fimbriectomy.
It sounds like you had a reversal with another provider and you should direct your questions and concerns to the person who did your tubal reversal surgery.You should not give yourself such a hard time because it is always easy to second guess yourself.