Open access tubal microsurgery
Through a bikini incision, the surgeon removes the tubes, under magnification, excises the occluded segment to the healthy mucosa and stitches the ends with 2-3 rows of 6/0-8/0 microsutures with precise matching of layers, which ensures tightness and patency; when the ampoule becomes clogged, it forms and inverts a new funnel. Patency is confirmed intraoperatively with dye. Open access is chosen for isthmic occlusion and reanastomosis (require precision technology), dense adhesions, and combined operations. To prevent adhesions, barrier gels and early activation are used; After 3 months, a control HSG is performed. In case of failure or reduced reserve - IVF.
Indications
- obstruction of the fallopian tubes in the isthmic region after inflammation, requiring resection and anastomosis;
- restoration of patency after surgical sterilization (reanastomosis) if pregnancy is desired;
- pronounced adhesions and scar changes in the tubes, when laparoscopic plastic surgery is impossible;
- combination with other open operations (myomectomy, cyst removal).
Forecast
The success of reconstruction depends on the length of the remaining tube (at least 4 cm), the condition of the mucosa and the absence of damage to the fimbriae: after reanastomosis for sterilization, pregnancy occurs in 50-70% of women, after plastic surgery for inflammatory occlusion - in 20-40%, the risk of ectopic pregnancy is 5-10%. In case of damaged mucous membrane, short tubes and age over 38–40 years, IVF is more effective. Microsurgical technique with magnification, atraumatic threads and minimal coagulation is the key to the result.
When to choose laparotomy
Open access through a transverse Pfannenstiel incision (along the bikini line) remains the method of choice for very large sizes of the uterus and formations, multiple fibroids with deep nodes, severe adhesions after many operations, suspected malignancy with the need for revision, severe heart and lung diseases in which pneumoperitoneum is undesirable, as well as when laparoscopy is unavailable. Laparotomy gives the surgeon direct control of the tissue and a reliable multi-layer suture on the uterus; the scar after cosmetic suturing is barely noticeable. Recovery is longer than after laparoscopy: hospital stay 3–6 days, exercise limitation 1.5–2 months.
