Introduction

Fallopian tube obstruction is a common disease that leads to female infertility. Laparoscopy can comprehensively observe and understand the scope and degree of adhesion around fallopian tubes and ovaries, whether fallopian tubes are unobstructed, identify the obstruction site, and perform fallopian tube plastic stoma surgery.

Indications

• Infertility patients with obstruction of the distal fallopian tube and hydrosalpinx in the ampulla of the fallopian tube.
• Oviduct ovary and pelvic adhesion.

Surgical procedures and techniques

Take the bladder lithotomy position and insert the uterine fallopian tube through vagina.

Understand pelvic conditions under laparoscope. 

The fallopian tube on the affected side shall be lifted by the non-destructive forceps to separate the surrounding adhesion.

                                        severe hydrosalpinx on both sides

Salpingostomy And Salpingoplasty

Fix the distal tube wall of the fallopian tube with non-destructive forceps. 

If part of the umbrella end is visible, insert the separating forceps into the fallopian tube, and gradually expand and separate until there is water flowing out. 

In case of complete atresia, use micro scissors to cut the umbrella end of fallopian tube along the longitudinal axis of fallopian tube in a petal shape (Fig. 2, Fig. 3).

Figure 2 left salpingostomy

Figure 3 right salpingostomy

Fallopian tube infusion test

Inject normal saline containing methylene blue into the vaginal catheter, and observe whether there is blue liquid overflow at the stoma end under the microscope (Fig. 4).

Fig. 4 Methylene blue solution after salpingostomy

Turn over the cut umbrella end mucosa, and use 3-0 absorbable suture to intermittently sew 3~4 stitches of each valve at about 1cm from the port (Fig. 5~ Fig. 10).

Figure 5 left oviduct fimbrial mucosa eversion

Figure 6 after left fallopian tube fimbria plasty

Fig. 7 right fallopian tube umbrella end forming

Figure 8 right oviduct fimbrial mucosa eversion

Figure 9 right fallopian tube fimbria after operation

Figure 10 bilateral salpingostomy

Intraoperative risk and Prevention

1. wound bleeding

In the process of separating adhesion, the non vascular area shall be cut off with electrocoagulation shear or separated with bipolar electric hook. If the adhesion is thick or there are blood vessels, it can be cut off after electrocoagulation. The broken end after separation shall be carefully inspected to avoid bleeding.

2. fallopian tube injury

To separate the adhesion around the fallopian tube and reasonably use energy instruments in the process of fallopian tube plastic stoma, try to avoid thermal damage to the fallopian tube, and try to avoid forced tearing of the fallopian tube during stoma.

3. fallopian tube perforation

If the fallopian tube is blocked at the proximal end through inspection, the liquid can be passed through the positioning intubation under the official endoscope, but special care should be taken when inserting the catheter, and the fallopian tube should be closely observed through the laparoscope to prevent perforation.

4. abnormal formation of the umbrella end of fallopian tube

In the process of salpingostomy and umbrella end forming, it is necessary to grasp the size of the salpingostomy and the eversion suture spacing of the umbrella end according to the degree of salpingostomy. 

In case of bleeding at the umbrella end, try to avoid direct electrocoagulation and hemostasis on the mucosal surface of the umbrella end, so as to prevent the umbrella end from being closed again. Appropriate compression or suture can be used to stop bleeding.

Postoperative precautions

1. pelvic cavity, abdominal cavity and fallopian tube adhesion again

When the operation was completed, a large amount of normal saline or dexamethasone normal saline was used to wash the pelvic and abdominal cavity; 

Adhesion wound surface is coated with sodium hyaluronate gel to prevent adhesion, Encouraging patients to get out of bed early after operation can also reduce the risk of re adhesion.

2. strengthen education and guide patients’ pregnancy

According to the fallopian tube dredging during the operation, guide the patients to try pregnancy after the operation. Some patients may have hydrosalpinx atresia again after the operation. After the operation, inform them how to grasp the opportunity of natural pregnancy and the period of pregnancy test, assisted reproductive means, etc.

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