Microsurgical Salpingostomy

Outpatient Tubal Ligation Reversal

Fimbriectomy reversal (Microsurgical Salpingostomy)

Salpingostomy

Fimbriectomy differs from other methods of tubal ligation.

Fimbriectomy is performed by removing the fimbrial and infundibular portion of the fallopian tube next to the ovary, leaving behind one tubal segment attached to the uterus. The other, and more common, methods of tubal ligation leave behind 2 tubal segments with the fimbrial end still present. This is true whether the fallopian tube has been separated by ligation and resection, electrocoagulation, or mechanical obstruction. After fimbriectomy, the remaining tubal segment can be opened by the technique of microsurgical salpingostomy.

Microsurgical salpingostomy is performed by creating a small opening in the remaining end of the fallopian tube with a microsurgical needle electrode. The newly created opening is then enlarged and gently folded back like the petals of a flower to allow the internal endothelial lining to emerge and extend over the opened tubal end. Since healthy tubal endothelium is covered with cilia - the hairline projections that beat in coordinated waves - the new tubal opening or ostium can capture an egg as it is released from the ovary and propel it into the tube just as the fimbrial end of the tube does normally. Fine sutures are carefully placed around the circumference of the folded back end of the fallopian tube and an adhesion barrier is gently placed over it to prevent scar formation.

The illustration shows the steps involved in microsurgical salpingostomy. First, a microsurgical electrode is used to open the tubal end and expose the internal endothelial lining. When the opening has been enlarged sufficiently and the endothelium has extruded from the tubal end, sutures are placed to keep the endothelium folded outward over the edge and to prevent the tube from closing again.

Repair of Hydrosalpinx

The technique of microsurgical salpingostomy also can be used to repair a fallopian tube that has become blocked at its end as a result of pelvic inflammatory disease (PID). In some cases of tubal closure from PID, a hydrosalpinx may form. (Hydrosalpinx is a fallopian tube closed at its fimbrial end and with fluid in it.) In the case of hydrosalpinx, the ciliary lining at the fimbrial end of the fallopian tube may be damaged. If so, the fimbrial end of the tube with damaged endothelium is removed and the remaining tube repaired with the same technique as after a fimbriectomy.

The pregnancy rate at one year following microsurgical salpingostomy is approximately 40%.

Microsurgery

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