Salpingectomy

What is Salpingectomy?

Salpingectomy is an operative procedure, wherein a woman’s one or both the Fallopian tubes are removed.

The Fallopian tubes anatomy

The constitution of the Fallopian tubes is similar to that of a tube, which makes an opening in a woman’s uterus bilaterally.  Each of the Fallopian tubes has four elements:

  • Infundibulum
  • ampulla
  • Isthmus and
  • Intramural

The infundibulum is extended with outcrops similar to that of the fingers, known as fimbriae. Beneath the fimbriae ovaries are located. The ampulla is a broader elementary component of the tube. The isthmus and the intramural get connected to the ampulla and make an entry into the uterine wall.

The Fallopian tubes carry the undeveloped egg from your ovaries towards the uterus. In case of the presence of a sperm there, it may penetrate the egg to fertilize it in the ampulla to make a zygote. The zygote afterwards moves through the Fallopian tube towards the uterus and develops as an embryo, where it gets implanted and becomes the fetus to be eventually born as a baby.

Kinds of Salpingectomy?

Salpingectomy can be of several types:

Partial Salpingectomy: wherein just a portion of the Fallopian tube is eliminated

Total or complete Salpingectomy: In this, the whole Fallopian tube is eliminated

Bilateral Salpingectomy, wherein (both) the Fallopian tubes are detached

Unilateral Salpingectomy:  wherein just 1 Fallopian tube is eliminated.

Salpingo-oophorectomy: wherein the ovaries are also eliminated with the Fallopian tubes

The warning signs of Salpingectomy?

Salpingectomy is performed in the following conditions, which may harm the Fallopian tubes, such as:

  • Ectopic (tubal) Pregnancy

Ectopic pregnancy is a state wherein the zygote, formed with the unification of sperm and the egg, stays out of the uterus instead of developing further within it. In ectopic pregnancy, after the egg fertilization in the Fallopian tube takes place, it gets implanted in the tube itself and begins growing in the constricted tube. In case the ectopic pregnancy is not eliminated surgically, it may develop the tubal rupture and the remains of the conception cause peritonitis, bleeding, fall in the blood pressure and even casualty.

  • Hydrosalpinx

Hydrosalpinx is the fluid buildup in the Fallopian tube(s), resulting in infertility.  . Elimination of hydrosalpinx before the  in vitro fertilization (IVF) increases the chances of achieving pregnancy.

  • Infections

Pelvic Inflammatory Disease and STI infections, like Chlamydia, Syphilis and Gonorrhea restrict the proper functioning of the Fallopian tubes.

  • Fallopian tube cancer

The females, who run a risk of developing ovarian cancer, there is also a danger of their spreading the disease to the Fallopian tubes also. In the salpingectomy procedure, the ovaries are eliminated with the Fallopian tubes. The American Congress of Obstetricians and Gynecologists recommended this in a report publicized in 2015.

Besides the elimination of the uterus, a total hysterectomy of the abdomen and bilateral salpingo-oophorectomy are performed.

Preoperative examinations before the Salpingectomy

Before the salpingectomy procedure, certain examinations are performed for diagnosing and confirming the fundamental diseases, such as:
Pelvic and abdominal ultrasound

An ultrasound of the abdomen is generally performed for identifying the primary cause. While performing the ultrasound, a special gel is spread to the abdomen and a probing device is moved over it. Pictures are taken, which can be seen on a computer screen. The procedure is painless and safe and performed as an outpatient.

Hysterosalpingogram

During this examination, a contrast dye is placed in the uterus through the passage of the vagina with the help of a syringe. The dye moves from the uterus into the Fallopian tubes and then into the abdominal cavity for absorption. The pictures are seen with the imaging investigations. In case the Fallopian tubes are obstructed, the dye will not move out of the tube from the obstructed area and the X-ray also shows the narrow area of the tube.

Laparoscopy: Diagnostic laparoscopy is at times performed for directly viewing the Fallopian tubes and other organs in the abdomen for diagnosing issues with them.

Regular examinations

Regular examinations that are necessary before performing a surgery are:

Blood and other examinations, such as,

  • Blood group
  • Hemoglobin levels
  • Electrolytes and
  • Functioning of kidneys examinations
  • Usual urine examination
  • ECG is performed for ascertaining the heart electrical activity prior to anesthesia for ensuring that you are healthy before the surgery.
  • Chest X-ray is performed for ascertaining the presence of chest infection prior to anesthesia
  • In elderly women, a comprehensive investigation of the heart is needed for ensuring that they are healthy enough for the surgery and undergoing anesthesia.

Salpingectomy Procedure

Salpingectomised may usually be performed as an open surgery with the help of a laparoscope.

Kind of Anesthesia – The procedure is performed by either giving general anesthesia or the regional anesthesia, where medicines are injected in the back for numbing the nerves of the spine.

In case you are given general anesthesia, you will fall asleep during the surgery and will not know what is happening during the operation.

Pre-surgery examinations – Regular examinations as mentioned above are recommended a few days before performing the procedure. You are required to be admitted in the Clinic a day prior to the procedure.

The day before the procedure – At times, an enema is performed the previous evening before the procedure. Some Clinics prefer giving laxatives instead the previous evening.

Fasting before the procedure – Fasting overnight is needed and sometimes fluid is introduced intravenously for keeping you well hydrated. Sometimes sedatives are prescribed for relaxed sleep during the night prior to performing the procedure.

Around one hour prior to the procedure, you may be transferred to the waiting room of the Operation Theatre on a trolley.

Once the Operation Theatre is set, you may be transferred to the Theatre.

Transfer to the Operation Theatre

The Operation Theatre ambience may at times be frightening and for overcoming your anxiety you may be given a small dose of sedatives. You will be transferred from the trolley to the surgery table. As you begin looking up, you may notice a light console and at the top end an anesthesia machine. You may also see some screens for checking parameters, such as ECG, oxygen level etc vital for the doctor for performing the procedure. You may also hear a regular beeping sound coming from the screens (monitors), which may be quite annoying.

Anesthesia before the procedure

While undergoing general anesthesia, the anesthetist (specialist) may introduce medications intravenously and make you draw in certain gases via a mask, which will place you in profound sleep.

In your profound sleep, a tube will be placed in your mouth and the windpipe for administering the anesthesia gases, which will help in making you comfortable and overcoming pain. In case of regional anesthesia, the medicines will be injected into the lower spinal area.

  • The Procedure

After anesthetizing you, a cut (incision) will be made in the lower abdominal area. In case of laparoscopic procedure, small incisions (cuts) are made for passing laparoscope and other surgical devices. In laparoscopy, the abdomen is blown up using carbon dioxide, which helps in viewing the reproductive organs in a better way.

After identifying the Fallopian tube, it is estranged from the tissues surrounding it whilst managing the bleeding. The uterine end of the tube is tied and slashed. In certain cases, in place of ligatures, either endocoagulation, endoscopic staples, laser or cautery is used. At times, along with the Fallopian tubes, the ovary is also eliminated. However, some younger females want to preserve their fertility and the functioning of the ovaries.  In such cases, the ovaries are kept intact. The technique is repeated on the other side in females going through bilateral salpingectomy.  Subsequently, the cut (incision) is closed.

  • General Anesthesia

After completing the procedure, once you are awake, the windpipe tube is removed. You may be told to open your eyes before removing the tube. You may still be under sedation and the anesthetist voice may appear to be faint.  After removing the tube, there is a possibility of your experiencing cough and at times nausea.

Your doctor may have introduced a Ryle or nasogastric tube in your stomach for draining out the gastric contents. You may also notice an intravenous line.

While continuing you on oxygen, all the tubes and pipes are carefully removed. After you come out of anesthesia, you may be transferred on the trolley for taking you to the recovery room.

  • Recovery Room

Once shifted to the recovery room, a staff nurse may scrutinize your essentials and keep you under observation before transferring you to a ward or the room.

  • Post-surgery Recovery

You may continue to be hospitalized for a number of days after the surgery. With a laparoscopic procedure, the recovery time and the hospitalization duration get reduced.  After the surgery, you are allowed to take light diet.

For preventing any kind of chest infection, chest physiotherapy is begun after a lapse of 24 hours after the procedure.

In case the salpingectomy is performed because of a ruptured pregnancy, you may be required to stay in the ICU for a night.  And, you may also have to undergo blood transfusion.

  • DVT Prophylaxis

Early mobilization and legs movement help in preventing deep vein thrombosis (DVT), wherein a clot gets created deep in the veins leg veins. This clot may journey to the lungs, causing a critical health issue.  Some other procedures like using special stockings or a small amount of heparin medication may also help.

As per the enormity of the pain, painkillers are prescribed. For preventing infection, antibiotics may be introduced intravenously.

Complications linked to Salpingectomy?

After the salpingectomy procedure, some health issues may crop up, like:
Problems linked to anesthesia

Harm to neighboring reproductive organs

Bleeding

Formation of infection

Persistent pain

Bilateral salpingectomy causes infertility.

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