Page 25 - World's Most Popular Laparoscopic Journal

Nomonde D Gumata

16
endometrium and/or the developing embryo. The toxic prior to the IVF procedure in women with hydrosalpinges
substances contained in hydrosalpinx fluid drain into the has been shown to improve the likelihood of successful
uterine cavity and dilute the endometrial secretion, and thus outcome. 23-26 These procedures can be performed via
generate an unfavorable uterine milieu. 18-20 Mukherjee et laparoscopy as well as laparotomy since, both routes are
21
al showed that the hydrosalpinx fluid enters into the uterine equally effective although laparoscopy is the preferred
21
cavity. Sonography done during the luteal phase in patients route. 15,27
with hydrosalpinx showed uterine cavity fluid distension
and none of these patients obtained an ongoing intrauterine SALPINGECTOMY
pregnancy after IVF treatment. 22 Laparoscopic salpingectomy prior to IVF is usually
performed in women who have unilateral hydrosalpinx with
DIAGNOSIS OF HYDROSALPINX USING normal contralateral tube as well as those with bilateral
IMAGING TECHNIQUES hydrosalpinges, and results in significant improvement in
27
pregnancy and implantation after surgery. Evidence
Hydrosalpinx can be diagnosed using various imaging
2
techniques. Most of these investigations can only assess suggests that laparoscopic salpingectomy should be
the tubal patency with few assessing the tubal function performed only when hydrosalpinges are beyond repair or
30-32
(functional status of tubal mucosa). 2,3 in cases of IVF failure. Thin-walled hydrosalpinges with
Tubal patency tests, such as HSG, hysterosalpingo- mucosal adhesions and thick-walled hydrosalpinges with
contrast ultrasonography (HyCoSy), TVUS and laparoscopy absent mucosal folds diagnosed using salpingoscopy are
33
indications for salpingectomy.
are not good at assessing tubal function. 2,3
Tubal function tests, such as falloscopy, salpingoscopy FUNCTIONAL OR RECONSTRUCTIVE
and fertiloscopy are the main tests that should be utilized to TUBAL SURGERY
assess the functional status of the tubal mucosa. These
tests are new interventions utilizing tubal endoscopy. 4,5 Functional or reconstructive tubal surgery remains
Salpingoscopy can be used to classify hydrosalpinx into another important tubal surgical treatment, complement to
four types (Table 1). assisted reproductive techniques (ARTs). 33,34 This surgery
should be considered as first-line treatment when the
Table 1: Classification of hydrosalpinges based on
salpingoscopy 2,6 correction of infertility pathology is achievable and
33
good results are expected. It should be preferred to
• Thin-walled hydrosalpinx with a healthy mucosa
• Thin-walled hydrosalpinx with flattened mucosal folds without salpingectomy in mild forms of hydrosalpinges, especially
mucosal adhesions (hydrosalpinx simplex) those with preserved tubal mucosa without adhesions
• Thin-walled with mucosal adhesions (hydrosalpinx follicularis) (diagnosed using salpingoscopy) as these hydrosalpinges
• Thick-walled hydrosalpinx with absent mucosal folds.
are amenable to surgical repair and have good prognosis. 8
Thin-walled hydrosalpinx and a healthy mucosa have
good results postsurgery. 8 Fimbrioplasty
Tubal function tests play an important role in choosing Fimbrioplasty is the incision of any fibrous or scar tissue
patients suitable for tubal surgery (functional tubal surgery covering the terminal end of the tube, thus freeing the
or salpingectomy). 2 agglutinated fimbriae and lysis of peritubal adhesions. 34
Fimbrioplasty is, thus, indicated in patients with fimbrial
HYDROSALPINX TUBAL SURGERY occlusion usually with concurrent periadnexal adhesions. 35,36

Although IVF is the main treatment for tubal factor infertility
related to hydrosalpinx, surgical treatment plays a crucial Salpingostomy or Neosalpingostomy
role prior to IVF, and scientific evidence has shown it to Salpingostomy is the procedure whereby a stoma is fashioned
improve pregnancy outcomes by removing the toxic effects in the distal fallopian tube using scissors, electrosurgery or
35
23
of hydrosalpinx that impair IVF outcomes. The laser. The procedure can be performed using laparoscopy
performance of surgical interventions, such as salpingectomy or laparotomy with microsurgical technique. 36,37 When the
and functional or reconstruction surgery (fimbrioplasty, procedure is performed for mild hydrosalpinges, it is
salpingostomy and microsurgical tubocornual anastomosis), associated with better pregnancy rates. 34

146
JAYPEE