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How are fallopian tubes removed. Removal of fallopian tubes

The operation to remove the uterine tube is the second most common after ovarian resection. According to statistics, about 3-12% of women go through such a procedure. More often one fallopian tube is removed, but sometimes both have to be removed at once. The operation itself is called a tubectomy or salpingectomy.

In what cases is the fallopian tube removed?

Depending on the indications, tubectomy is performed as planned or urgently. The operation is necessary for inflammatory processes in the pipes or ectopic pregnancy.

The intervention is considered radical and causes irreversible consequences, therefore it has clear indications for carrying out:

Formation of repeated ectopic tubal pregnancy.
Adhesions in the pelvis that have spread to the tubes.
Pyosalpinx is a purulent inflammation.
Unilateral or bilateral hydrosalpinx.
Ectopic pregnancy with diameter gestational sac over 30 mm.
Torsion of the legs of the ovarian cystoma or its rupture.
Severe deformities due to salpingitis or adnexitis.
IVF planning against the background of long-term hydrosalpinx (observed for six months).
Severe illnesses intestines with involvement of appendages.
Bleeding after a failed salpingostomy. This is plastic with excision of the overgrown ampullar section of the tube and sewing it to the peritoneum.
Hysterectomy for neoplasms: large or multiple fibroids, malignant tumor of the ovaries, cervix or body of the uterus.

Preparing for a salpingectomy

The removal of the uterine tubes is carried out under anesthesia, so the woman is previously examined. It includes the following laboratory and instrumental diagnostic methods:

Fluorography or radiography chest. This study helps to detect signs of tuberculosis or other diseases. respiratory system.
Blood analysis. Detects infections, inflammatory processes and diseases of internal organs. For accuracy, blood is taken on an empty stomach.
Colposcopy. This is a study of the walls of the vagina and cervix, which helps the doctor to identify suspicious areas of the mucosa.
Analysis of urine. For research, they give the morning portion of urine. The study helps to assess the work of the kidneys, identify violations water-salt metabolism.
Testing for HIV, syphilis, hepatitis. If there is one of these diseases, then doctors take measures to prevent complications. The study is carried out using ELISA.
Ultrasound of the internal genital organs. It is carried out to assess their condition and select the optimal method of intervention.
Coagulogram. This is a blood clotting test. Any operation is associated with blood loss, so the doctor needs to assess the risks. Blood for a coagulogram is taken from a vein.
Electrocardiogram. Necessary for assessing the condition of the heart. This allows you to identify contraindications for surgery, the optimal intervention strategy, dosage and type of anesthesia.
A smear from the cervix and vaginal mucosa for flora and purity. This test looks for possible genital infections.

The last study is carried out during the examination by a gynecologist. After all the procedures, the woman is sent to the therapist to obtain consent for the operation. Before the procedure, there is a conversation with the anesthesiologist, who determines the best option for anesthesia and possible risks. Other nuances of preparing for the intervention:

A woman should tell her doctor about all medications she is taking.
Anti-inflammatory drugs, anticoagulants and antiaggregants should be discontinued 2 weeks before surgery.
On the evening before the operation, the woman is prescribed cleansing food. You can drink and eat no later than 12 hours before the intervention.
With strong excitement at night, a woman is given a sedative.
Immediately before the operation, the woman takes a shower, removes hair from the pubis and perineum, and changes clothes.

How is the fallopian tube removed

Resection is performed by one of two methods. The first way is laparotomy. This is an abdominal operation in which a large incision is made on the abdominal wall:

Longitudinal from the navel to the pubic joint. This is a lower midline laparotomy. It can be carried out with abundant adhesions, large benign neoplasms appendages, malignant tumors, pelvic peritonitis.
Transverse, just above the pubis along the fold of the skin (according to Pfannenstiel). This incision has a better cosmetic result and faster recovery. Such a laparotomy is performed when laparoscopy is not possible, but the intervention does not require urgency.
Longitudinal, slightly above and slightly below the navel. This is a median laparotomy, which is technically simpler and faster than other types of incision. In this way, urgent and emergency operations are performed for bleeding, developing peritonitis, or rupture of the cystic cavity of the appendages.

The second way to remove the uterine tube is laparoscopy. With this method, access to the organs is carried out using several punctures in the abdominal wall. The surgeon controls his actions using the image on the monitor. It is obtained through a microvideo camera, which is inserted along with instruments into the abdominal cavity.

If a woman has no evidence for emergency operation(intra-abdominal bleeding, etc.), then resection fallopian tube often performed laparoscopically. The advantages of this method compared to laparotomy:

less traumatic;
only small incisions remain (up to 1.5 cm);
less severe and not so long rehabilitation.

Laparoscopy

The cost of such an operation varies between 30-50 thousand rubles. Laparoscopy does not last long - about 40 minutes. After the operation, the woman regains consciousness within 1-2 hours. auspicious time for laparoscopy - 7-10th day of the menstrual cycle.

With this operation, both endotracheal combined anesthesia and epidural anesthesia are possible. Laparoscopy technique:

Several incisions are made in the abdominal wall: near the navel, above the pubis and in the lower abdomen.
Trocars are installed in them, through which the necessary instruments are introduced. A Veress needle is inserted into one, which ensures the creation of pneumoperitoneum - inflating the abdominal cavity due to injection carbon dioxide or oxygen for better view.
An endoscope and other laparoscopic instruments are inserted into the remaining holes.
After suctioning the blood, the patient's pelvis is raised by 45 degrees to create the optimal position for the operation on the pelvic organs.
The doctor finds the tube to be removed, clamps as close as possible to the cut-off point and pulls.
Using forceps, laparoscopic scissors or a bipolar coagulator, the appendage is cut off.
Carry out coagulation of bleeding vessels and cut off upper part broad uterine ligament and isthmus of the tube.
The severed appendage is removed through the largest trocar to the outside.
Stitches are applied to the trocar holes, and sterile napkins are applied to the wounds.

Laparotomy

An abdominal operation is always performed under general anesthesia, therefore it lasts at least 1.5 hours. The cost of laparotomic tubectomy ranges from 10 to 20 thousand rubles. depending on the complexity of each case. General procedure for the operation:

After the introduction into anesthesia, the doctor performs a Pfannenstiel incision or another, depending on the indications for which the intervention is performed.
Blood that has entered the abdominal cavity is pumped out and collected in vials so that it can be transfused later.
The tubes and the uterus itself are removed to find the source of bleeding.
A clamp is applied to the isthmic part of the appendage and the mesentery.
The appendage is cut off, the peritoneum is sanitized and the dissected tissues are sutured.

Complications of salpingectomy

IN separate group include the effects of anesthesia. They go away on their own within a few hours or days. The list of such complications includes:

vomiting;
chills;
nausea;
weakness;
sore throat (due to tube intubation);
dizziness;
pain in the area of the postoperative wound.

Another group consists of the consequences of the operation itself. After a tubectomy, a woman may develop the following complications:

Hematomas in the peritoneal cavity or thicker subcutaneous adipose tissue. They can cause bleeding. This indicates problems with the blood clotting system or that the surgeon performed poor hemostasis.
Inflammation. It is indicated by a temperature that rises immediately or a couple of days after the operation.
Adhesions that disrupt the functioning of internal organs. They can occur both after laparotomy and after laparoscopy.
Bloody discharge from the vagina. Most often minor, occur after surgery to remove the pipe due to its rupture. Spotting is not considered a serious complication as it is caused by blood being thrown into the uterus during the operation.
Ectopic pregnancy. If it was the reason for the removal of one of the tubes, then the risk of its development in the remaining appendage is high.

The consequences of resection of the fallopian tube

Such an operation disrupts the maturation of the follicle, which causes the reproductive system to suffer. This complicates the process of ovulation - the release of a mature egg from the ovary. It is impossible to restore the fallopian tube after removal. The main consequence of the operation is the restriction or decrease in the function of childbearing. Surgery to remove the uterine tube causes neuro endocrine disorders. They are indicated by the following symptoms:

increased sweating;
headache;
pain in the region of the heart;
dizziness;
feeling of heartbeat;
flushes of blood to the upper part of the body;
irritability, nervousness;
dysfunction thyroid gland.

Judging by the reviews, these symptoms are aggravated during menstruation. They occur only in 42% of women who have undergone such an operation. Symptoms are more common in the early recovery period while the body is adjusting to the new condition. With bilateral tubectomy, the risk of such complications is higher. The consequences also apply to the mammary glands:

In 6% of patients, they become rude.
In 15% of cases, the breast becomes larger due to diffuse expansion of the lobules.

Recovery after tubectomy

When performing an operation by laparoscopy, a woman can go home in a couple of days. After laparotomy, she stays in the hospital for 10-14 days, until the stitches are removed. Already in the first days, recovery includes early activation. This helps to reduce the risk of thrombosis, intestinal paresis and pain. Adhesion prevention measures:

The introduction of barrier absorbable gels into the abdominal cavity before the completion of the operation.
Getting out of bed the next day after the procedure. Calm walking helps to minimize the risk of adhesions.
Carrying out electrophoresis with zinc and iodine.

According to the indications, doctors prescribe antibiotics and analgesics to the woman. On the first day, the patient is offered a light soup, cereals and drink, then they are introduced into the diet. dairy products and lean meat. You need to exclude foods with fiber from the diet, as they provoke increased gas formation.

After the removal of the tubes, the ovaries continue to produce eggs, the uterus is also preparing to receive the embryo, that is, the main functions are preserved. If one tube is preserved, then the woman can become pregnant. Rules for late recovery after tubectomy:

Sexual life can begin no earlier than a month after the operation and provided wellness.
Until the stitches are removed, they are kept clean and dry. Instead of a bath, they take a shower, closing the wounds from getting wet with a bandage.
Within a month, limit sports and intense physical activity. Sometimes for this period a woman is recommended to wear a bandage.
For six months after the removal of one or both fallopian tubes, you can not lift weights.
Within 6 months, a woman must take birth control to exclude pregnancy.

Resumption of the menstrual cycle

Recovery is different for every woman. Most often, menstrual irregularities are temporary. It can be restored with hormonal correction. Normal cycles often alternate with disturbed ones. Features of the restoration of menstruation:

If the body quickly adapted or happened hormonal imbalance, then menstruation can begin a couple of days after the operation. The first cycle will be longer than all previous ones.
Early onset of menstruation after tubectomy is rare. For most women, it comes in due date.
In other patients, the recovery of the cycle takes about 2 months. This is not considered a deviation. If the cycle has not returned to normal after 60 days, then you need to see a doctor, because there is a risk of endocrine disorders.

Pregnancy planning

The possibility of conceiving a child depends on the type of tubectomy performed. If only one fallopian tube was removed, then when it normal functioning pregnancy is possible, but the chances are reduced by at least 50%. The chance is even less if the remaining appendage is altered, inflamed, or has adhesions. If a woman does not have one fallopian tube, then the following options are possible:

Ovulation does not occur, the follicles begin their reverse development. More often than not, this is due to a hormonal imbalance.
The egg is released into the abdominal cavity. Since the fimbria of the tubes do not capture it, after 2 days it dies and collapses.
The egg floats in the abdominal cavity and reaches a healthy tube, through which it passes into the uterus. It will be easier to capture the follicle if it stands out from the ovary from the side of the preserved epididymis.

The probability of getting pregnant on your own with one fallopian tube averages 56-61%. Doctors advise planning a conception six months later, others recommend waiting 1-2 years. During this time, it is possible to normalize the work of the neuroendocrine system. Only then will the woman's body be ready to bear a child.

If both fallopian tubes were removed, then either the egg permanently dies in the peritoneal cavity, or the ovaries undergo reverse development. In this case, the only way to get pregnant is through in vitro fertilization(ECO). This procedure can be resorted to after 6-12 months.

Contraindications for tubectomy

Fallopian tube resection has the same limitations as others surgical interventions. This acute infections, bleeding disorders and decompensated diseases of internal organs. Contraindications for laparoscopic tubectomy:

rupture of the fallopian tube with severe bleeding;
decompensated diabetes mellitus;
cancer of the uterus and appendages;
3-4 degree of obesity;
myocardial infarction;
peritonitis;
stroke.

Video

Laparoscopy in gynecological practice is extremely common. This method is firmly established in the work of gynecological surgeons due to its low trauma and high efficiency, which does not interfere with the implementation of reproductive plans in the future, which is very important during operations on the pelvic organs.

Laparoscopy of the fallopian tubes is one of the most frequent operations gynecological profile. It has many indications, but the majority of patients are women who experience difficulties with the onset of pregnancy, because infertility has recently been extremely common.

According to statistics, about 40% of all difficulties with conception are caused by the pathology of the female reproductive system, and half of them are due to the fault of the fallopian tubes, which are impassable due to inflammatory processes, infections, the consequences of diseases and interventions in the past.

Laparoscopic tubal surgery is performed for both diagnostic and therapeutic purposes, and diagnosis can become a stage in the elimination of various pathologies, while the patient will not acquire a large scar on the abdominal wall and will quickly recover.

Tubal laparoscopy is an excellent alternative to open laparotomy, allowing the doctor to perform all the necessary manipulations on the pelvic organs, but at the same time it is very less traumatic, so rehabilitation after it is fast, and complications are rare. In modern surgery laparoscopy of the fallopian tubes - the main action for infertility, tumor lesions, adhesive disease, which is widely implemented in clinics in Russia and abroad.

Indications and contraindications for laparoscopy of the fallopian tubes

The reason for laparoscopic intervention on the pipes can be:

Infertility - one of the most common causes leading a woman to laparoscopy. In this case, it is diagnostic in nature, if the cause of infertility is not fully clarified, but during the operation, obstacles to pregnancy (adhesions, for example) can also be eliminated, which will simultaneously serve as a treatment for the existing pathology.

Adhesive disease with the development of cicatricial adhesions around the fallopian tubes - another common pathology, the cause of which can be both infectious and inflammatory processes (banal infection, STIs, tuberculosis, chlamydia, cytomegalovirus, etc.), and transferred in the past abdominal operations in this zone. In particular, appendectomy contributes to serious reproductive problems due to scarring, so laparoscopy of fallopian tube adhesions is a fairly common procedure for problems with childbearing.

ectopic pregnancy

Ectopic pregnancy, when the zygote attaches and begins to develop outside the uterus, most often it proceeds in the tube, from which, for one reason or another, the fertilized egg did not come out. This pathology belongs to the category of emergency surgical, because a pregnancy growing in a tube is a direct path to rupture of an organ and is fatal. dangerous bleeding. With such a pathology, laparoscopy is aimed at removing the affected tube along with the embryo.

Some experts suggest ways to remove the embryo laparoscopically with the preservation of the organ, but experience shows that almost all tubes preserved in this way are poorly passable in the future, and the risk of repeated tubal pregnancy in them increases significantly. In this regard, most gynecologists insist on the need for complete excision of the tube laparoscopically.

Impaired patency of pipes implies the need for diagnostic laparoscopy, during which the doctor determines the etiology of obstruction, its prevalence, and also finds out the possibility of eliminating the pathology. This laparoscopy can be supplemented by chromotubation when the degree of obstruction is diagnosed with a dye. A sterile dye is injected into the uterine cavity, and if the tube is not sclerosed, then it enters the abdominal cavity, which fixes the surgeon's eye.

Laparoscopy with patency of the fallopian tubes is carried out with a variety of pathologies that lie outside the lumen of the organ - endometriosis, paratubal cysts, benign tumors. Violations in the pipes can be expressed in the accumulation of pus (pyosalpinx), serous fluid (hydrosalpinx) in them, which also requires surgical treatment preferably by laparoscopic technique. Usually, the affected tube is removed entirely during the operation, because it is no longer able to perform its main function, and there will definitely not be any benefit from its presence.

If in infertility the main goal of laparoscopy is to achieve pregnancy, then sterilization - reverse situation. When there are already children, but there is no desire to have them again, a woman can decide how to surgical way contraception. This manipulation is also performed laparoscopically for patients who have reached the age of 35 and have at least two children. The result of laparoscopy will be irreversible, which the doctor must warn about.

Before prescribing laparoscopic intervention on the pipes, the gynecologist finds out the presence of obstacles, which can be absolute and relative.

Absolute contraindications to laparoscopy of the fallopian tubes are:

It is worth noting that some absolute contraindications may become relative if we will talk about saving lives. For example, a tubal pregnancy in a woman with bleeding disorders somehow requires surgical operation, and in this case, laparoscopy is preferable, because blood loss will be less than with conventional laparotomy.

TO relative obstacles include severe obesity, diabetes, high blood pressure, adhesive disease pronounced degree. For such patients, the possibility of intervention is determined individually based on the possible risk.

Preparation for treatment and anesthesia techniques

Laparoscopy of the fallopian tubes is impossible without proper preparation, the quality of which determines the degree of risk of complications and adverse effects. Before the planned surgical treatment, a woman will have to undergo a comprehensive examination, as well as to fully treat existing diseases, especially chronic ones.

The main goal of preparation is the prevention of subsequent complications, but the need for anesthesia is very important point during the entire intervention. Not only can anesthesia aggravate chronic disorders from the internal organs, but also become an absolute contraindication for certain diseases.

List necessary examinations before laparoscopic treatment is close to the standard before any operation. It includes:

General clinical blood and urine tests;
Fluorography;
Coagulogram;
Clarification of blood group and Rh factor;
Research on infections;
Electrocardiography.

In addition to analyzes general, an examination by a gynecologist is shown with the collection of the contents of the genital tract for flora, cytology of the cervix, ultrasonography appendages to clarify the nature and extent of changes.

Patients with extragenital diseases (diabetes, thyroid pathology, hypertension, bronchial asthma, etc.) must consult with the appropriate narrow specialists to address the issue of the safety of the operation and correction of the course chronic pathology before, during the intervention and in the postoperative period.

At the preparation stage, it is very important to tell the doctor about all the drugs you are taking, especially those that affect blood clotting. Anticoagulants, antiplatelet agents are canceled before laparoscopy, other drugs that the patient takes for a long time (hypotensive, for example) are prescribed in the required amount and cannot be canceled.

When all the examinations are completed, the woman goes to the therapist, who signs her consent to the laparoscopy. The permission of the therapist means that the operation will be safe and the risk of complications is minimal.

All examinations can be done at your clinic, but it is important that the period from the moment the tests are taken is no more than two weeks. If necessary, some studies can be duplicated on the eve of the intervention (coagulogram, for example).

On the appointed day, the patient comes to the clinic, where she is examined by the attending physician, who makes sure that she is complete. preoperative preparation. The gynecologist once again explains the essence of the intervention and its necessity, and also enlists the woman's written consent for surgical treatment.

On the day of admission, an anesthesiologist necessarily comes, because anesthesia is an integral and extremely an important part any operation. Tubal laparoscopy requires general anesthesia, and the anesthesiologist carefully monitors the indicators blood pressure, pulse, blood oxygen saturation, etc., so it is so important to tell the doctor about all the medications you take, existing diseases, allergies.

Anesthesia can be mask, when anesthetics are administered intravenously, and nitrous oxide is inhaled through the mask, or endotracheal with maintenance artificial ventilation respiratory organs. Endotracheal anesthesia has the advantage of being able to accurately dose toxic medicines for anesthesia and a lower risk of leakage of gastric contents into the respiratory tract.

On the day before the operation, the patient is limited in food, excluding foods that provoke bloating, and in the evening does not eat or drink at all. Before going to bed, she takes a shower, shaves off the hair from the external genitalia, changes into clean linen. An enema is given to cleanse the intestines and facilitate the imposition of pneumoperitoneum.

In order to prevent thromboembolic complications, especially with already diagnosed varicose veins or other problems with blood vessels, elastic bandaging of the legs is indicated. It will be possible to remove the bandages after laparoscopy, when the doctor considers it safe.

Fallopian tube laparoscopy technique

Laparoscopy on the tubes is indicated as a planned treatment or is performed urgently in life-threatening conditions (bleeding and rupture of the tube during ectopic pregnancy, cyst torsion). It is diagnostic and therapeutic.

Diagnostic laparoscopy aims to accurately establish the nature of the pathology, when other methods of non-surgical examination have not brought desired result. It makes it possible to determine the cause of infertility and immediately, simultaneously, eliminate it. Therapeutic laparoscopy is indicated for established diagnosis to liquidate pathological process or is a continuation of the diagnostic operation. Repeat laparoscopy may be indicated to monitor previous treatment.

Laparoscopy in the patency of the fallopian tubes is aimed at removing the existing changes in them, which do not necessarily cause infertility, but are dangerous for their complications - torsion of the cyst or its suppuration, endometriosis. With organ obstruction, the main goal is to restore the lumen and the possibility of conception with subsequent uterine pregnancy.

Laparoscopic removal of the fallopian tube indicated when it is impossible or inappropriate to preserve it - tubal pregnancy, hydro- or pyosalpinx, severe endometriosis. In this case, the tube is cut off from the surrounding tissues, carefully coagulating the vessels, and then taken out through one of the trocar holes. Additional incisions to remove the organ to the outside are not required.

fallopian tube laparoscopy

Fallopian tube laparoscopy is performed in the operating room. general anesthesia. Usually it takes 20-40 minutes, maximum an hour, but in difficult situations extended to one and a half hours or more.

Before the introduction of instruments, the puncture zone is treated with antiseptics, and then three trocars are inserted - hollow tubes with a sharp inner rod. Through the trocars, a video camera, a light source and the necessary tools are placed inside the abdomen - forceps, coagulators, clamps, retractors, etc.

To facilitate the surgeon's actions and create free space, gas (pneumoperitoneum) is injected into the abdomen, lifting the abdominal wall. It is delivered through the 1st puncture in the umbilical region. A video camera is inserted through the second puncture, and tools through the third. The surgeon monitors the entire course of the operation on the screen, while receiving a tenfold increase in internal organs.

Using laparoscopic instruments, the surgeon can dissect the adhesions and isolate the pipes from them to restore their patency, remove tumor-like processes on the pipe or the entire pipe itself, if indicated.

da vinci system

Modern laparoscopic technology offers a number of automated systems (robots) that facilitate the work of the operator and make laparoscopy more efficient. For example, application da Vinci systems gives a number of advantages:

Minimal blood loss and low tissue trauma;
less pain during recovery period;
Virtually zero risk of infectious complications;
Fast recovery.

The high-tech equipment of the Da Vinci system allows you to get a high-quality three-dimensional image of organs, the device itself is controlled by the surgeon. The robot has 4 "arms" through which laparoscopy is performed. During the intervention, the device performs smooth actions controlled by the doctor, so the inaccuracy or trembling of the hands of the operator is excluded. The Da Vinci system is more functional than trocar instruments, the probability of traumatizing the surrounding structures is reduced to zero.

Significant disadvantages of robotic laparoscopy can be considered the high cost of equipment and the need for staff training, which affects the availability and cost of the operation itself, therefore, despite the undoubted advantages of the method, not every hospital and not every patient can afford it.

After completing all necessary action on the pipes, the surgeon coagulates the vessels, makes sure that there is no bleeding, once again examines the area of intervention, and then takes the instruments out. The puncture sites are sutured. Drainage is not usually necessary, but if purulent processes drainage can be left in the pipes in the small pelvis for the first days of the postoperative period.

Postoperative period and its complications

The postoperative period after laparoscopy of the fallopian tubes usually proceeds easily, because the method of operation itself has a lot of advantages - low trauma, no large incision, speed of execution, minimal risk complications.

After the operation, the patient is taken to the ward, where, after coming out of anesthesia, she can get up in the evening of the same day. Early activation is the key to a successful recovery, so you should not stay too long in bed, it will even be useful to just walk along the ward or corridor of the hospital. Walking will not only help the fastest healing tissues, but will also serve as an excellent prevention of postoperative problems with the intestines (constipation), as well as such serious complications like thrombosis of the veins of the legs.

Laparoscopy does not require long-term hospitalization, so after 3-4 days the patient goes home, and the sutures are removed by the end of the first week after the intervention. Rehabilitation takes about a week on average, but to resume sexual life And the doctor will recommend sports activities no earlier than in a month. A couple of weeks is enough to heal the external sutures and restore bowel function, but the patient must remember that internal incisions regenerate longer, so heavy lifting and heavy physical labor should be limited for the first 3-6 months after the intervention.

In the first couple of days, a woman may feel pain at the puncture sites, as well as the shoulder girdle and abdomen, which is associated with gas injection during laparoscopy. Usually these symptoms go away on their own without leaving any consequences.

Postoperative intestinal paresis - frequent occurrence after any operation, which manifests itself in soreness, bloating, constipation. To fight him shown physical activity and maintaining a sparing diet that excludes fatty and fried foods, carbonated drinks and foods that increase gas formation (cabbage, legumes, pastries). For several days it is better to eat fractionally, preferably light soups, cereals, steamed meat, without loading digestive system a large amount of food.

Since interventions on the appendages are often performed due to infertility, women are very concerned about the issue of pregnancy after laparoscopy of the fallopian tubes. It is believed that if adhesions outside the tube were the cause of infertility, then laparoscopy will restore fertility in more than half of those operated on.

The issue of planning pregnancy after laparoscopy must be approached responsibly. The first month is healing internal seams, and in 2-3 months the chances of getting pregnant are maximum, so it is better not to postpone conception for a significant period. After six months, the likelihood of pregnancy begins to gradually decrease due to possible education solder, therefore the first three months is the period recommended by experts for its onset.

If conception has occurred, and a happy woman holds in her hands positive test for pregnancy, then you still can’t relax, because the risk of ectopic development of the fetus after laparoscopy increases, especially if the operation was performed for obstruction of the tubes or adhesions. In this regard, you should carefully monitor your well-being, immediately go to a consultation and regularly undergo all recommended examinations.

Complications after laparoscopy are rare, although they are possible. These include bleeding, neighboring bodies purulent-inflammatory processes. The consequences of the operation may be repeated ectopic pregnancy and adhesions in the pelvis, further reducing the likelihood of childbearing in the future.

The operation to remove the fallopian tube is called a salpingectomy. It is performed when the fallopian tube is severely damaged, or if there is severe, persistent bleeding after salpingotomy. In addition, the operation is performed if the woman does not plan to have children in the future (for example, when an ectopic pregnancy developed after tubal ligation).

Removal of the fallopian tube is performed through laparoscopic salpingectomy, while the mesentery is dissected with an electrocoagulator. After that, special staplers or ligatures are used.

Indications for the operation

If some time ago the operation was performed by the abdominal method, then laparoscopy is currently mainly used, since this method is much easier to tolerate by patients.

The operation is necessary only in case of severe damage or inflammation of this organ, or in the event of an ectopic pregnancy, and can be performed on one or both sides.

Mandatory indications for surgical treatment are:

Severe damage, deformation of the fallopian tubes, as well as when filling them with liquid.

If there are extensions.

If their patency is impaired.

Sometimes surgery is recommended before artificial insemination(ECO). The fact is that if fluid accumulates in the tubes, it, getting into the uterine cavity, washes out the embryos. In addition, embryos in the uterus can die from exposure to pathogenic, pathogenic microflora that is present in an inflamed fallopian tube.

Therefore, if the affected organ is not removed, the probability normal pregnancy after artificial insemination is significantly reduced, sometimes up to 30%. Whereas removal assumes the successful onset and course of a normal pregnancy, as well as normal delivery in about 60% of cases.

It must be added that surgical removal fallopian tubes negatively affect the process of maturation of the follicles and makes it difficult to ovulate.

The doctor determines the need for surgery in individually for each patient. However, with a significant, extensive lesion, for example, if a large size of the hydrosalpinx is detected, or if it exists for a long time (more than six months), an operation is indicated. The presence and size of the inflammatory process is established using ultrasound of the pelvic organs.

Operation technique:

After the surgeon performs a laparotomy and carefully examines the pelvic organs, the appendages of the side from which the operation is performed are removed from the abdominal cavity. Then on the broad ligament of the uterus and uterine end pipes are superimposed with special surgical clamps. Then the pipe is cut off above them, and the clamps are replaced with ligatures. The remaining section of the broad ligament is sutured along its entire length.

Plastic surgery of the fallopian tubes

Plastic surgery is often performed immediately after surgical treatment obstruction. It is performed using a variety of microsurgical techniques. During plasty, the pipe tissue is aligned, which has undergone deformation during the removal of adhesions. After plastic surgery, there are no scars on the fallopian tube, which always remain as a result of surgical intervention.

During surgical treatment, the pipes can be exposed to a variety of influences. Therefore, plastic surgery can be varying degrees difficulties. It depends on the extent of the damage internal organ. For example, with the help of plastic surgery, a new pessary. Implantation of damaged sections of the pipes can be carried out. In especially difficult cases, it is possible to use several types of microsurgical operations at once.

Meaning plastic surgery after surgical treatment of this important female organ hard to underestimate. The fact is that after recovery with the help of plastic surgery, in 40-90% of cases, the onset and successful course of pregnancy is possible, successfully ending in childbirth.

Indeed, the percentage spread is quite high, but it has its own explanation. The fact is that the pathologies of the pipes can be very different, sometimes quite complex. Often it depends on individual characteristics operated women. After all, each of them has its own characteristics in the structure of the genital organs. The effect of plastic surgery of the fallopian tubes also depends on the general condition of the woman during the rehabilitation period.

Of course, the likelihood of conceiving a child after the removal of one fallopian tube is reduced. But there is no need to despair. A lot in this case depends on the state of health of the woman who underwent the operation, and the patency of the tube that remains. Therefore, careful observance medical advice, the implementation of the prescribed procedures, should allow you to experience the happiness of motherhood in the future. Be healthy!

Svetlana, www.site

Removal of the fallopian tube is an operation that is performed by many women in different ages. Sometimes doctors have to cut one, and sometimes two tubes at once. Statistics indicate that from 3 to 12% of women go through the procedure for removing appendages.

General state body, according to some experts, is not disturbed, because the fallopian tubes are only a transport system for the egg and sperm.

However, there are a number of scientific works that prove the opposite point of view. The authors point out that menstrual irregularities, hormonal disruptions and other problems with the female reproductive system occur most often in those patients who underwent removal of the fallopian tubes.

Salpingectomy is a surgical intervention, the purpose of which is to remove the fallopian tube. Another name for the procedure is tubectomy. During its implementation, one or both appendages are removed. The procedure can be carried out for vital indications on an emergency basis. If the patient's life is not in danger, then tubectomy is planned.

Indications for salpingectomy:

Growth and development of the embryo in the cavity of the tube. On an emergency basis, the procedure is carried out when the embryo ruptures the appendage and the woman's internal opens.

If an ectopic pregnancy is formed a second time in the same tube.

Adhesions of the small pelvis that grow into tubes.

Ectopic pregnancy, which is not subject to conservative therapy(when the diameter of the fetal egg exceeds 30 mm). Concerning conservative method treatment of ectopic pregnancy, then it is implemented in order for the woman to be able to become pregnant on her own in the future. In this case, the fetal egg is pushed into the ampullar part of the tube, or a salpingostomy is applied to it.

The tube can be removed when the salpingostomy was unsuccessful and complicated by bleeding.

With severe deformities of the fallopian tube against the background or salpingitis. The tube is removed when it functionality not recoverable.

Formation of pyosalpinx (accumulation of pus in the lumen of one or both fallopian tubes).

Planning for in vitro fertilization. Doctors in some cases insist on the removal of the fallopian tubes, citing the fact that IVF may be ineffective. The fact is that reverse current is possible inflammatory exudate from the tubes into the uterine cavity and "washout" of the implanted, but not implanted, fetal egg. In addition, if an inflammatory process occurs in the tubes, this can lead to a toxic effect on the embryo. Sometimes it happens that the implanted embryo begins to take root in the uterus, but after some time, due to inflammation in the tubes, a woman has a miscarriage. Therefore, if a patient has hydrosalpinx for six months and she plans IVF, then the doctors insist on the preliminary removal of the fallopian tubes.

The presence of hydrosalpinx itself, without IVF planning, may be an indication for removal of the fallopian tube. This is especially true for those patients in whom the hydrosalpinx has an impressive size.

A combination of hysterectomy is possible (the operation is used for pathologies of the uterus, for malignant neoplasms of the ovaries, etc.) and tubectomy.

Most often, the doctor decides on the possibility of removing or preserving the fallopian tubes after or during diagnostic laparoscopy.

How the fallopian tubes are removed: the essence of the procedure

There are two types of fallopian tube surgery: laparoscopy and laparotomy. Laparoscopic intervention is a priority, it has a minimum set of contraindications, does not require extensive incisions to gain access to the fallopian tubes, and does not injure tissues and organs. In addition, patients after it recover quickly enough, and the rehabilitation period itself is much easier than after laparotomy.

If a tube rupture occurs against the background of an ectopic pregnancy, then this process is almost always accompanied by severe bleeding. development is not excluded hemorrhagic shock and other complications, up to death. Therefore, in such a situation, a woman can only do a laparotomy. In parallel, intensive infusion-transfusion therapy will be carried out. Only thanks to the implementation of an emergency operation, it is possible to save a woman's life.

Stages of laparotomy:

The introduction of general anesthesia.

Making an incision: according to Pfannenstiel (transverse incision above the womb) or an incision in the anterior wall of the peritoneum, below the umbilical zone.

Pumping out blood that has entered the abdominal cavity. The blood is collected in separate vials to be able to transfuse it later. However, autologous blood transfusion is available only if the patient is free of inflammation.

Extraction of the uterus and appendages in order to find the source of bleeding.

The imposition of a clamp on the isthmic part of the appendage, as well as on the mesentery. This allows you to stop the bleeding.

Cut off the fallopian tube.

Sanitation of the peritoneum and suturing.

During laparoscopy, the surgeon performs similar actions, but the blood pumped out of the peritoneum is not transfused to a woman.

If possible, the pipes are removed not completely, but partially.

Indications for resection of the fallopian tubes:

The presence of adhesions only in a small area of the fallopian tube.

An ectopic pregnancy that has just begun to develop.

benign tumor in one of the corners of the uterus.

The decision on whether it is possible to remove only part of the fallopian tube is made on an individual basis.

Contraindications for laparoscopy of the fallopian tubes

Laparoscopic method can not remove the fallopian tubes in the presence of the following contraindications:

Peritonitis.

Rupture of the fallopian tube, accompanied by severe bleeding.

Nervousness, irritability, tearfulness;

Painful sensations in the region of the heart;

Increased sweating;

Congestion of blood to the upper half of the body.

Symptoms tend to intensify before the next menstruation, and they are far from disturbing all women (they are observed in about 42% of cases).

About 35% of patients after 2-3 months after removal of the appendage notice menstrual irregularities. During the passage of ultrasound, they are diagnosed with an increase in the size of the ovary on the side where the fallopian tube was removed. Over time, it undergoes sclerotic changes, which is due to a violation of the flow of lymph and blood.

There is also an alternation of normal menstrual cycles with disturbed ones. Perhaps a decrease in the efficiency of the luteal body, the cessation of ovulation. However similar states are rarely observed.

From the side of the mammary glands, the following changes occur:

The glands become engorged in 6% of patients;

The breast becomes larger due to diffuse expansion of the lobules in 15% of patients;

Grows in size thyroid, its work is disturbed in 26% of patients;

It is also possible to develop the following symptoms: weight gain, the appearance of body hair, the formation of stretch marks on the skin.

These symptoms are especially pronounced in those women who have undergone surgery to remove both appendages.

In the early rehabilitation period, a woman is shown the introduction of antibiotics, which helps prevent the development of possible inflammation.

To minimize the risk of adhesion formation, the following measures are taken:

Doctors try to use laparoscopic surgery whenever possible, which is characterized by minimal trauma.

Before completion of the operation, absorbable barrier gels are introduced into the abdominal cavity. For some time they contribute to the fact that the surfaces of organs are at a distance from each other. This is a measure aimed at preventing adhesion formation.

The patient is raised the next day after the operation.

A woman is prescribed physiotherapeutic procedures: electrophoresis with iodine and zinc.

Calm walking and other moderate exercise can prevent the formation of adhesions, or minimize the risk of their formation.

After the operation, the woman is prescribed a course of antibiotics, subcutaneous injections aloe extract for 14 days. Possible appointment vaginal suppositories Longidaza.

For 6 months after the removal of the fallopian tubes, it is imperative to take contraceptives to prevent pregnancy.

It is important to take good care of postoperative sutures, which will prevent their inflammation. You need to refuse to take a bath, you should wash yourself in the shower. In this case, the seams must be closed so that water does not get into them.

For a month after the operation, doctors recommend that patients wear slimming underwear.

intimacy is under an absolute ban during the first month after the surgery.

stick to any special diet no need. However, you should temporarily exclude from your menu products that increase gas formation in the intestines. Therefore, you need to give up legumes, whole milk, yeast baked goods and pastries, cereals, meat and carbonated drinks.

After the operation, for several days, a woman may experience bloody issues from the vagina. This is normal, especially when a tube has ruptured or a hematosalpinx has been removed. It is not worth considering spotting as a complication of the operation, since they are explained by the reflux of blood into the uterus during the surgical intervention or before it begins.

If the body quickly adapted, or happened hormonal disbalance against the background of an existing disease, then a few days after the removal of the appendages, a woman may begin another menstruation. Moreover, this cycle can be longer than all previous ones. With minor blood loss, characteristic of standard menstrual bleeding, you should not worry about this. If the blood loss is impressive, then curettage of the uterus and blood transfusion may be required.

Early onset of menstruation after surgery is observed infrequently, in the vast majority of cases, menstruation comes on time. Although sometimes it happens that the cycle is restored for at least two months. This is also not a deviation from the norm. If after 60 days after the operation the cycle has not stabilized, then you need to contact the doctor. It is possible that the operation caused endocrine disorders that require professional correction.

Can you get pregnant without fallopian tubes?

Woman getting pregnant without fallopian tubes natural way can not. At the moment, doctors have not been able to develop an analogue of the fallopian tubes, although they have been trying to make them for many years. The first attempt to implant artificial appendages was carried out in the 70s of the last century. However, it was not successful, so it did not take root in medicine.

The only method that can help women conceive and bear a child without both fallopian tubes is in vitro fertilization.

If there is no fallopian tube, where does the egg go?

When both fallopian tubes are in place, they capture the egg released from the ovary into the abdominal cavity with fimbriae, and gradually move it into the uterus. It is also possible for a sperm to meet an egg in the tube and fertilize it. In the peritoneal cavity, the egg is able to exist for two days, after which it dies.

When a woman has one tube missing, the following options are possible:

Ovulation will not occur, the follicles will begin their reverse development. This situation is most often observed against the background of hormonal failure.

The egg will go into the abdominal cavity, and after 2 days it will die and be destroyed in it.

The egg will float in the abdominal cavity, it can reach the tube that has remained intact, and pass through it to the uterus.

Of course, it is much easier for fimbriae to capture the egg that is secreted by the ovary from the side of a healthy tube. If both appendages are removed from a woman, then the ovaries either undergo reverse development, or the egg will constantly die in the peritoneal cavity.

When can I plan to conceive after surgery?

A woman after the removal of one fallopian tube will be able to become pregnant on her own in 56-61% of cases. Moreover, this does not depend on the type of surgical intervention. Doctors point out that it is necessary to plan a pregnancy no earlier than six months after the operation. A number of experts do recommend that a woman wait 1-2 years, taking oral contraceptives. During this time, it will be possible to normalize the work of the neuroendocrine system and the body will be ready to bear the child.

After removal of the fallopian tubes, 42% of patients develop infertility, and in 40% of cases, the ovaries stop working with their former strength. Moreover, the risk of developing an ectopic pregnancy is 10 times higher. Therefore, IVF is the only method that allows a woman to conceive a child after the removal of the fallopian tubes.

Can tubal plasty replace them?

Gynecological surgeons may perform surgery to repair part of the fallopian tube, calling the procedure a fallopian tubeplasty. It is carried out after removal of the deformed portion of the appendage.

Concerning full recovery fallopian tubes, then this operation is not advisable. The fact is that a woman’s own appendages have the ability to contract so that the egg can move along them and reach the uterus. After plastic surgery, the pipes lose their ability to contract, which means that fertilization will be impossible. Therefore, the operation is carried out only when a small area of the appendage needs to be replaced.

Education: Diploma in Obstetrics and Gynecology obtained from the Russian State medical university Federal Agency for Health and Social Development (2010). In 2013, she completed her postgraduate studies at the NMU. N. I. Pirogov.

The fallopian tubes in the female body are the connecting elements between the uterus, abdominal cavity and ovaries. Their main purpose is that through them the fertilized egg passes into the uterine cavity.

However, according to different reasons there may be situations in which gynecologists recommend that women remove these tubes. Of course, the female is interested in the question of whether it is possible to become pregnant after the tubes are removed.

Gynecologists reassure the fair sex and claim that they have a chance to become a mother if they use such a procedure as in vitro fertilization.

Why are tubes removed?

The removal of the tubes can occur with different volumes, depending on what specific indications each patient has. women can do:

Partial removal of pipes.
Complete removal (both unilateral and bilateral).

The need to remove the fallopian tubes may occur for the following reasons:

Significant damage to the tissues of the pipes themselves during surgical interventions, or other forms of injury.
Infection of tissue and tubal sheaths inflammatory processes different etiology.
Complicated incessant bleeding (for example, during salpingotomy during ectopic pregnancy).
Salpingitis.
There are expansions or other significant deformations in the fallopian tubes.
The pipes are filled with liquid.
Artificial insemination is planned.

Many women try to refuse to remove the tubes, citing the fact that they do not yet have children or are still planning a pregnancy. But if the affected tubes are not removed, then the embryo will die in the uterus from pathogenic microflora present in the pipes.

Removing the affected tubes, on the contrary, increases the chances of a normal pregnancy and successful delivery after IVF.

How is the removal operation performed?

Surgery during which the fallopian tubes are removed medical practice has a salpingectomy.

This type of operation has replaced the abdominal type of operation. With band intervention, the incisions must be made much larger than with laparoscopy.

Therefore, salpingectomy is tolerated by patients much easier. The operation takes place in the following sequence:

With the help of a laparotomy, the surgeon examines the pelvic organs.
Next, the peritoneum is removed from the side where the tube needs to be removed or from both sides (if two tubes are removed at once).
Special surgical clips are put on the end of the fallopian tube and on the broad ligament of the uterus.
The section of the pipe that is between the clamps is cut off.
Replacing clamps with ligatures.
The surgeon sews up the remaining section of the broad ligament along the entire length.

What are the consequences of laparoscopy of the fallopian tubes

Of course, as with any surgical operation, after the removal of the fallopian tubes, a woman will have to face a number of postoperative complications.

The table lists the main consequences that may occur after excision of the fallopian tubes:

Consequences	Explanation
A significant increase in the risk of infertility.	If a woman has one tube removed, then the chances of pregnancy are reduced by 50%. When removing two tubes, conception naturally can't be at all. In this case, help the woman
Increased risk of tubal pregnancy.	After the removal of one of the pipes, and if there are adhesions in the second, the woman is threatened with a tubal pregnancy.
The appearance of acute pain in the pelvic area.	This symptom may indicate that adhesions have formed in the pelvic area. In this case, it is imperative to consult a doctor.

The gynecologist-surgeon must warn the patient in advance about these consequences.

How is rehabilitation carried out

Laparoscopy of the fallopian tubes requires a recovery period. The female body is experiencing a serious shock, so it must be helped to recover.

Recovery when one tube is removed is slightly different from recovery when two fallopian tubes are removed at once.

If the patient had an excision of one tube, then the restorative procedures include:

Appointment of anti-inflammatory therapy. This is necessary in order to prevent problems with patency in the second pipe.
Women are often prescribed electrophoresis.
The course of absorbable drugs. These include: vitreous body, aloe.

Once again, we note that all these procedures are aimed at preventing the formation adhesive process in the second pipe. If adhesions begin to form there, then it is a big question.

Compliance with moderate physical activity.
Compliance with the rules of good nutrition.

When two tubes are removed at once, the following types of restorative treatment will be prescribed to patients:

A course of drugs to restore the functional layer of the endometrium.
to regulate general hormonal background organism.

The presence of a normal functional layer of the endometrium and hormonal balance are key success factors for in vitro fertilization.

How does menstruation go after tubes are removed?

Many women ask gynecologists the question of whether they will continue to have menstruation. The answer to this question is positive. Women will continue to have regular menstrual cycle. It will begin after the restoration of the functionality of the ovaries.

Can tubal plasty replace them?

In gynecological practice, such a term as "plastic of the fallopian tubes" is known. It is often carried out with partial removal damaged areas fallopian tubes.

Complete restoration of the fallopian tubes does not make any sense. Since a normal fallopian tube has the ability to contract. This property is necessary for the fertilized egg to move through the tube to the uterus.

After plastic surgery, the fallopian tubes do not have the ability to contract, which means that the promotion of the egg through them will be impossible.

Partial plastic surgery of the fallopian tubes, when only individual damaged areas are replaced, has importance For female body. With such operations, depending on their complexity and on the volume of replaced tubal tissues and the successful course of pregnancy by 40 - 90%.