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10.5005/jp-journals-10007-1101 WJOLS
REVIEW ARTICLE Hydrosalpinx: Functional Surgery or Salpingectomy
Hydrosalpinx: Functional Surgery or

Salpingectomy

Nomonde D Gumata
Department of Obstetrics and Gynecology, Kalafong Hospital, University of Pretoria, South Africa

Abstract
1
Background: Hydrosalpinx is a common cause of female infertility and adversely affects the outcomes of in vitro fertilization (IVF).
Although IVF is the main treatment, alternative treatments, such as salpingectomy and functional tubal surgery have been suggested. 2
Previously, hydrosalpinx was diagnosed using tubal patency tests (transvaginal ultrasound, TVUS; hysterosalpingography, HSG; and
laparoscopy), which do not assess tubal function hydrosalpinx, and salpingectomy was the main surgical treatment for hydrosalpinx
3
prior to IVF. However, with modern tubal endoscopy (salpingoscopy and fertiloscopy) 4-7 and their ability to assess tubal functional
mucosa, functional tubal surgery can be considered for thin-walled hydrosalpinx and a healthy mucosa and salpingectomy performed
for thin-walled hydrosalpinx with mucosal adhesions and thick-walled hydrosalpinx with absent mucosal folds. 8
Aims and objectives: The aim of the review is to highlight the use of appropriate tubal function tests to help in making a choice between
either salpingectomy or functional tubal surgery as the treatment for hydrosalpinges.
Materials and methods: A literature search was performed using the search engine Google, HighWire press, PubMed and SpringerLink.
Selected papers were taken for further references. All articles, including randomized controlled trial (RCT) were included for the review.
8
Results: Vasquez et al suggested that mucosal adhesions are the most important factors in determining fertility outcomes especially in
thin-walled hydrosalpinges. Several studies on hydrosalpinges have also shown that the absence of mucosal adhesions on salpingoscopy
9
can identify patients who can benefit from advantages offered by reconstructive surgery. 3-7 Boer Meisel et al showed that patients with
thin-walled hydrosalpinges and well preserved mucosa had an intrauterine pregnancy rate of 77% and a tubal pregnancy rate of 4%
9
8
following reconstructive surgery. Vasquez et al in their prospective study showed that thin-walled hydrosalpinges with a normal or
8
flattened mucosa, but without mucosal adhesions were associated with a 58% pregnancy rate and low risk of tubal pregnancy. Their
study also found that thick-walled hydrosalpinges with mucosal adhesions have a statistically significant lower intrauterine pregnancy
8
10
rate. Dechaud et al showed that salpingectomy for thick-walled hydrosalpinges improved the outcome of IVF.
Conclusion: An appropriate tubal mucosal assessment should be a routine prior to deciding upon further management of hydrosalpinx.
Functional tubal surgery should be preferred in mild forms of hydrosalpinx and salpingectomy reserved for severe forms of hydrosalpinx.
Keywords: Hydrosalpinx, Salpingectomy, Functional tubal surgery, Fimbrioplasty, Salpingostomy, Uterine tubal anastomosis, Tubal
function tests, Salpingoscopy and Fertiloscopy.

INTRODUCTION Hydrosalpinx is a common cause of female infertility 1
and accounts for between 26 and 30% of patients with
Hydrosalpinx, also known as fallopian tube obstruction, is 15
defined as a fluid filled distension of the fallopian tube in the infertility treated with IVF.
11
presence of distal tubal occlusion. It is one form of tubal
disease and may involve the proximal, distal or the entire HYDROSALPINX EFFECTS ON
PREGNANCY OUTCOMES
11
fallopian tube. The occlusion is almost secondary to pelvic
inflammatory diseases (PID), endometriosis, fimbrial serosal Women with hydrosalpinges have lower implantation rates
1
obstruction following an adjacent appendicular inflammation of 2.9% and lower pregnancy rates of 9.2%, as well as
and previous surgery (either tubal, pelvic or abdominal). 12 higher ectopic pregnancy rate and early pregnancy losses
PID being the most common cause of hydrosalpinx results of 70%. 16,17
in a severe inflammatory process obstructing the distal end The exact mechanism of such low pregnancy outcomes
16
of the fallopian tube. 12,13 This inflammatory process is unclear with many postulated hypotheses. Mechanical
combined with the natural transitional cell mucosa production and chemical factors as well as endometrial receptivity
produce a swollen nonfunctioning hydrosalpinx fluid. 13 dysfunction have been implicated and shown to adversely
16
Hydrosalpinx can be classified according to severity of tubal impair IVF outcomes. Andersen et al postulated that the
damage into: Mild/grade I, moderate/grade II and severe/ low pregnancy outcomes might be due to leakage of fluid
grade III. 14 into the uterine cavity which disturbs the receptivity of the

World Journal of Laparoscopic Surgery, September-December 2010;3(3):145-150 145