When to remove the pipe
If a pipe ruptures, the operation is an emergency: at the same time the bleeding stops, the pipe is removed, blood is evacuated from the abdominal cavity, and blood loss is replaced. Routinely, tubectomy is performed for hydrosalpinx before IVF (almost doubles the implantation rate), chronic purulent inflammation of the tube and recurrent ectopic pregnancy. Removing one tube while the other is healthy does not significantly reduce the chance of natural conception - ovulation alternates, and the tube can “pick up” an egg from the opposite ovary; removal of both tubes is the path to IVF with preserved ovarian function. Pregnancy tissue is sent for histology.
Indications
- tubal pregnancy - progressive or disturbed (tubal abortion, tubal rupture) according to ultrasound and hCG;
- intra-abdominal bleeding due to a pipe rupture - emergency surgery;
- hydrosalpinx, pyosalpinx, irreversibly changed tube, recurrent tubal pregnancy in the same tube (tubectomy);
- removal of tubes before IVF for hydrosalpinx.
Save or delete pipe
With a progressive tubal pregnancy of small size in a woman who wants to preserve fertility, and with a healthy second tube, organ-preserving salpingotomy is possible; in case of a rupture, a large ovum, a repeat pregnancy in the same tube, a destroyed wall and a healthy second tube, tubectomy is preferable - it excludes a repeat ectopic in this tube and does not reduce the chances of a natural pregnancy with a intact second tube. Both options are performed laparoscopically, even with intra-abdominal bleeding in a stable condition; The removed tissue is examined histologically, hCG is controlled to zero.
Benefits of laparoscopy
Laparoscopy is the standard of modern operative gynecology: magnifying the image by 10–15 times allows you to work more accurately than an open operation and is more gentle on the ovarian tissue and tubes, blood loss is minimal, adhesions form less frequently (important for future pregnancy), the pain after the operation is mild, and the patient gets up on the day of the operation and is discharged on the 1st–3rd day; Instead of a cut, three barely noticeable scars remain. In the clinics below, laparoscopic operations are performed by gynecological surgeons with extensive experience on modern endoscopic stands.
Risks and contraindications
- rare complications: bleeding, injury to neighboring organs, infection, thrombosis - prevention and the experience of the surgeon reduce the risk to a minimum;
- contraindications: severe heart and lung diseases, coagulation disorders, severe adhesions after many operations, large tumors (>15–20 cm) - then laparotomy is chosen;
- Obesity and previous operations are not a contraindication, but require an experienced team.
