Definition and Overview
A tuboplasty refers to a number of surgical procedures performed when the fallopian tubes are obstructed or if the patient wishes to reverse the effects of tubal ligation, a surgical birth control method that involves severing and tying the fallopian tubes. The goal of tuboplasty is to increase a woman's chances of getting pregnant.
The fallopian tubes are integral parts of the female reproductive system and are responsible for the passage of the ova (egg cells) from the ovary into the uterus. However, certain factors and conditions can lead to their obstruction including infection and the formation of scar tissue. In such cases, the egg cell is prevented from reaching the uterus resulting in female infertility.
Tuboplasty can be performed using either traditional open surgery or through minimally invasive methods, depending on the cause of the obstruction and the patient’s unique circumstances. The surgeon—typically one trained in obstetrics and gynaecology— usually performs diagnostic and imaging procedures (such as ultrasound) as well as considers all factors surrounding each particular case when deciding which method is the best for individual patients.
Who Should Undergo and Expected Results
Women with an obstruction in their fallopian tubes—especially those who want to increase their chances of having a successful IVF procedure—can undergo a tuboplasty.
Obstruction in the fallopian tubes can be caused by a variety of factors including the following:
- Pelvic inflammatory disease, or PID – This refers to an infection that affects the upper part of the female reproductive system, including other organs such as the uterus, fallopian tubes, and ovaries. Symptoms include abnormal vaginal discharge, pain in the lower abdomen, fever, burning sensation during urination or sexual intercourse, and irregular menstruation.
- Infections after childbirth
- Endometriosis, which involves the inflammation of the inner lining of the uterus, known as the endometrium
- Intraabdominal infections, such as appendicitis (inflammation of the appendix) and peritonitis (inflammation of the peritoneum, the thin lining of tissue in the inner wall of the abdomen)
- Ectopic pregnancy (where the fertilisation of the ovum occurred outside the uterus)
- Formation of scar tissue
- Damage to the fallopian tubes, which is typically caused by complications of an earlier surgery in the female reproductive system.
As for the expected outcome, women who have undergone tuboplasty and who are trying to conceive through natural or artificial means will have an increased chance of getting pregnant.
How is the Procedure Performed?
Before tuboplasty is performed, the patient undergoes an ultrasound to view the fallopian tubes and determine the location of the blockage. Depending on the patient’s condition and unique circumstances, as well as the surgeon’s recommendations, a tuboplasty can then be performed using any of the following techniques:
- Tubal reanastomosis - This involves the resectioning of occluded or damaged tissues in the fallopian tubes and then suturing the remaining healthy segments together.
- Fimbrioplasty. Also known as laparoscopic neosalpingostomy, this procedure involves the reconstruction of the fimbria, a part of the fallopian tube connected to the ovary, which facilitates the entrance of egg cells into the fallopian tube.
- Salpingostomy. This procedure simply opens the fallopian tubes by removing the obstruction, without performing surgical intervention on other parts of the organ.
- Salpingolysis. This involves cutting away scar tissue that obstructs the fallopian tubes.
- Cornual implantation. This involves the resection of an obstructed or damaged section of the fallopian tubes. The ends of the resected fallopian tubes are then connected to the uterus and linked to the endometrial cavity.
Tuboplasty can be performed using the following techniques:
- Laparotomy – This involves a large incision through the wall of the abdomen to access the abdominal cavity
- Laparoscopy – This requires a small incision in the abdomen or pelvis where small surgical instruments—including a camera—are inserted to perform minimally invasive procedures
- Microsurgery – This uses an operating microscope
- Laser surgery
- Electrocauterisation - This destroys tissue through heat conduction and electric currents
- Use of devices such as adhesion barriers, hoods, and surgical stents
- Mechanical dissection
Possible Risks and Complications
A tuboplasty can result in:
- Excessive bleeding
- Adverse reactions to the anaesthesia used
- Damage or perforation of surrounding organs
Deffieux X, Morin Surroca M, Faivre E, Pages F, Fernandez H, Gervaise A. Tubal anastomosis after tubal sterilisation: a review. Arch Gynecol Obstet. 2011 May;283(5):1149-58. PMID: 21331539 www.ncbi.nlm.nih.gov/pubmed/21331539.
Monteith CW, Berger GS, Zerden ML. Pregnancy success after hysteroscopic sterilisation reversal. Obstet Gynecol. 2014 Dec;124(6):1183-9. PMID: 25415170 www.ncbi.nlm.nih.gov/pubmed/25415170.