Salpingostomy

A salpingostomy is a surgery, wherein an incision is made into a Fallopian tube. This method is performed for removing an ectopic pregnancy, which happens outside the uterus or repairing a damaged tube.

Purpose

The Fallopian tubes are the constitution for carrying a mature egg from your ovaries to the womb. These tubes are found on the superior sides of the external uterus and have an opening into the womb via small channels. The unification of a sperm in a male’s semen and an egg and, thus, fertilization, also takes place in the Fallopian tubes.

In a standard pregnancy, the fertilized egg moves from the Fallopian tubes into the uterus and subsequently, get implanted in the uterine lining. In case the fertilized egg gets implanted elsewhere outside of the uterus, the pregnancy is known as ectopic or tubal pregnancy.  In a majority of cases, the ectopic pregnancies happen in the Fallopian tubes (about 95 percent).  The other places of it happening are:

With the advancing ectopic pregnancy, the Fallopian tubes are not able to carry the developing embryo and it may get ruptured warranting an emergency medical attention as it may result in excessive bleeding because of the hemorrhaging.

In case an ectopic pregnancy is detected early, much before the rupture has happened; it is possible to control it clinically. The methotrexate medicine attacks the speedily dividing cells of the fetus, obstructing its advancing growth. In case such a clinical control not achievable or has been unsuccessful, the control is done with surgery. A salpingostomy is, thus, done for removing the pregnancy.

Salpingostomy is also done for restoring fertility in females, whose Fallopian tubes are severely damaged because of the adhesions of scar tissues after undergoing a trauma or a surgery. Hydrosalpinx is a condition, wherein a tube gets blocked and filled with contaminated fluid and salpingostomy is performed for creating a new tubal opening (ostium).

Statistical analysis

Ectopic pregnancies happen among nearly 2 percent of the total pregnancies. A female, who has developed an ectopic pregnancy, runs a 10 to 25 percent higher probability of getting a yet another. Higher incidences of developing ectopic pregnancy are reported among females between 25 and 34 years of age, although older females, 35 and above see nearly 3 to 6 times higher mortality rate. A few females also run an increased risk to life because of ectopic pregnancy.

Detailed explanation

Salpingostomy is performed through laparoscopy or laparotomy by giving general anesthesia. At laparotomy, an incision (cut) is made into the wall of the abdomen for visualizing the Fallopian tubes. In case any of the tube is found to be already ruptured because of developing an ectopic pregnancy, a salpingectomy is performed for removing the spoiled Fallopian tube.  In case no rapture is found, vasopressin medicine is introduced into the Fallopian tube via an injection for reducing the bleeding.

A linear salpingostomy, wherein an incision is done through the tube wall, in the ectopic pregnancy growth region. The remains of conception are subsequently taken out of the tube with a device, known as a suction irrigator. The bleeding places are cured by stitching them up or with application of forceps pressure. However, the incision is kept open for healing in the course of time.  Thereafter, the abdominal wall is closed.

A neosalpingostomy is parallel to a linear salpingostomy. It is done for clearing the tubal blockage, like hydrosalpinx. For creating a fresh opening in the Fallopian tube, an incision is made, the tissue creased up and sutured.

The fresh ostium or opening substitutes the usual opening Fallopian tube opening where through the egg released by one of the ovaries is collected every menstrual cycle upon ovulation  (in case ovulation does not happen, it is known as anovulation)

Salpingostomy is also done with the help of laparoscopy. In this surgery, a tube like device, laparoscope, is used fitted with a light source, small lens and a tiny camera.  The laparoscope is introduced through the abdominal wall by making a small cut (incision) around the navel area for viewing the abdominal cavity on the screen.

Subsequently, the salpingostomy is performed with the help of devices introduced through Trocars, by making small cuts (incisions) into the abdominal wall.

If compared with the laparotomy the laparoscopic salpingostomy is more advantageous because it is not much invasive, less painful and the recovery time is also speedy. As compared to laparotomy procedure recovery time of nearly 5 weeks, the recovery period after the laparoscopy is less than 3 weeks.

Besides, the incision made in the abdominal area in laparoscopy helps the treating surgeon to view and the reproductive organs more clearly and also easier access to them.

Many studies suggest a higher probability of normal pregnancy after the laparoscopic salpingostomy as compared to salpingostomy performed with laparotomy.

Preparation and Diagnosis

As per estimation, nearly 40 to 50 percent of ectopic pregnancies are wrongly diagnosed when transferred to an emergency wing doctors. The ectopic pregnancy symptoms are often confused with other medical conditions, like pelvic inflammatory disease or miscarriage. The diagnosis generally depends on the symptom presentation, a +vie pregnancy test and the pregnancy confirmation out of the uterus by ultrasound.

Hydrosalpinx detection or other faults in the Fallopian tubes are performed by a surgical operation, wherein laparoscope is used for visualizing the Fallopian tubes. Else, a hysterosalpingogram  is performed, wherein the a dye is flown in the uterus and an X-ray is done for seeing if the dye comes out of the Fallopian tubes or not.

Recovery

In case the salpingtostomy is performed by making an abdominal incision, the procedure needs 3 to 6 weeks for complete recovery. In case the salpingostomy is done with the help of laparoscopy, the procedure needs less than 3 weeks time for full recovery.

During the initial few days after the procedure, you may be confronted with some uneasiness in the area of the incision, but mostly the females undergoing the surgery begin walking by the 3rd day.  The females undergoing the procedure may resume their usual activities, like working, exercising and driving within a month’s time.

Risks

The complications linked to the salpingostomy procedure include:

  • Growth of infection
  • Reaction to anesthesia
  • Injuries to other reproductive organs
  • Excessive bleeding

In the case of growth of ectopic pregnancy, there is a probability that not the entire remains of conception will get eliminated and that the unrelenting tissues may continue to grow, requiring further treatment.

Normal outcomes

In an ectopic pregnancy case, the conception remains are eliminated without causing any considerable harm to the female fertility. In case salpingostomy procedure is performed for restoring fertility, the technique will enhance the probability of a female achieving conception without seeking the help of any Artificial Reproductive Techniques (ART).

Mortality rates

The 97 percent females having an ectopic pregnancy are confronted with abdominal pain, 79 percent vaginal bleeding, 91 percent abdominal tenderness & 15 percent infertility. Nearly about 5 to 10 percent females are confronted with ectopic pregnancy persistently even after surgical cures.

Ectopic pregnancy is responsible for nearly 10 to 15 percent of all motherly deaths.  That means 1 among 2500 deaths is because of developing an ectopic pregnancy.

Alternatives

Around 25 per cent ectopic pregnancies are able to resolve themselves.   However, there is certainly a probability of the Fallopian tube rupture during the observing period. Treating the Fallopian tubes with methotrexate is becoming popular and its success rates are found to be like laparoscopic salpingostomy.  In case the patient is found to be stable, many doses of the medicine are given. Salpingectomy is an additional surgical choice in case the tube is badly damaged or has developed a rupture.

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