Objective: This study aims to illustrate our laparoscopic salpingostomy approach for two types of hydrosalpinx, emphasizing various reproductive surgical techniques.
Design: A step-by-step demonstration of the technique is provided alongside narrated video footage.
Setting: University hospital.
Patient(s): Infertile patients with hydrosalpinx seeking natural conception.
Intervention(s): Laparoscopic salpingostomy for clubbed hydrosalpinx is demonstrated with video and includes the following steps: 1) creating an opening into the tube at the terminal end for hydrosalpingeal fluid drainage; 2) dissecting and removing peritubal and periovarian adhesions; 3) excising redundant fimbrial tissues to restore fimbrial mobility; 4) evert the mucosa using an intussusception method until endothelial folds are visible; 5) confirming tubal patency with a dye test; 6) heating the serosal surface of the tube to evert the edges; 7) suturing the edges using 6-0 vicryl to the proximal serosa of the tube circumferentially with an inverting suture technique; 8) thoroughly irrigating with Ringer's solution to remove blood clots and debris; and 9) applying auto-crosslinked hyaluronan gel to the exposed raw surface. Salpingostomy for the cystic type differs, notably in carefully shaving the adhesive tubal end from the ovary until the tubo-ovarian ligament is completely exposed.
Main outcome measure(s): The primary aim of salpingostomy is to reduce the likelihood of distal tube re-obstruction. If hydrosalpinx recurs after salpingostomy, there remains a possibility of requiring additional surgery, such as salpingectomy, prior to IVF.
Result: (s): Extensive adhesions were meticulously dissected and removed from the peritoneal cavity. Fimbrial mobility was restored to establish a patent fallopian tube capable of ovum pickup. Electrocoagulation and suturing techniques were employed to evert the tube edges, effectively reducing the risk of re-obstruction. The utilization of an inverting suture technique aided in inwardly turning the cut edges, minimizing the risk of adhesion formation.
Conclusion(s): Laparoscopic salpingostomy, when performed by surgeons proficient in reproductive surgical techniques, provides a significant option for patients with hydrosalpinx seeking natural conception. The decision to preform salpingostomy or salpingectomy is usually made intraoperatively on the basis of the severity of tubal disease. Clinical history is also an important factor in decision to perform salpingostomy.
Keywords: Laparoscopic salpingostomy; hydrosalpinx; infertility.
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