Diagnosis of tubal disease
Proximal tubal disease is usually diagnosed either from a hysterosalpingogram (HSG), or using a frequently performed gynaecological procedure called a laparoscopy. HSG does not require any anaesthetic and takes 15-20 minutes. It is similar to having a cervical smear with a small amount of radio-opaque dye passed through the cervix and X-Ray images taken of the pelvis. A HSG not only provides invaluable information about the fallopian tube, it also checks the uterine cavity.
A laparoscopy is the process whereby a camera is inserted through the belly button (umbilicus) to look at the pelvic and abdominal organs. It is performed under General Anaesthetic as a day case procedure. Laparoscopy is also useful for checking for other conditions at the same time, such as endometriosis and adhesions and checking whether the fallopian tubes are open and look normal.
Tubal surgery was developed several decades ago however since this time there have been dramatic improvement in technique known as microsurgical procedures, enhancing success rates and decreasing the risk of post-operative scarring. These microsurgical procedures involve high operative magnification and the use of very fine sutures to minimise scarring.
Depending on the type of disease, corrective tubal surgery can be performed either by open surgery (laparotomy) or keyhole surgery (laparoscopy). The success rates of tubal surgery depend on the extent and severity of the underlying disease, as well as on the presence of other factors such as a lack of ovulation or a severe sperm problem on the male side.
Patients who benefit from surgery are generally those with:
- Disease in the tube adjacent to the uterus (proximal disease) – up to 68% success rates may be achieved
- Mild disease at the distal end of the fallopian tube (near the ovary) - success rates up to 44%
- Tubes which have been blocked deliberately for sterilisation purposes – these can be unblocked in a process known as microsurgical reversal of sterilization with success rates up to 85%
- Hydrosalpinges (in patients about to undergo IVF) - the tube may be coagulated to prevent toxic fluid from entering the uterine cavity and reducing implantation rates. The risk of ectopic pregnancy is also reduced
Patients with low success rates from tubal surgery are those with:
- Severe distal disease
- Disease which affects the entire tube from top to bottom (pantubular disease)
- Disease which affects both the proximal and distal end (known as Bipolar Tubal disease)