Gynaecology
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie in Bailey & Love's Short Practice of Surgery, 2018
Surgical management occurs in the form of a salpingectomy (removal of the Fallopian tube) or salpingostomy (opening of the Fallopian tube and extraction of the pregnancy tissue). This is ideally performed laparoscopically in the stable patient, as it is associated with shorter operative times, less intraoperative blood loss, shorter hospital stays and similar subsequent intrauterine pregnancy rates. A laparotomy may be required if the woman is haemodynamically unstable. A salpingectomy is the preferential technique in the presence of a contralateral healthy Fallopian tube. A salpingostomy is associated with an 8% risk of persistent trophoblastic tissue, intra-abdominal bleeding and an increased risk of a repeat ectopic pregnancy. These patients are subsequently followed up with monitoring of serum P-hCG levels until a negative result is obtained, to exclude the presence of residual trophoblastic tissue. If a further ectopic pregnancy occurs within the same Fallopian tube, then a salpingectomy is recommended regardless of the condition of the contralateral tube.
Alternative Modes of Tissue Coagulation and Removal
Sujoy K. Guba in Bioengineering in Reproductive Medicine, 2020
Removal of periadnexal adhesions can be carried out by electrosurgical techniques and subjects the normal tissue to less tension and trauma than operation with ordinary surgical tools. With the advent of lasers, for a time it was felt that the laser method gives far better results than electrosurgery. But recent critical assessments both on animal models and humans have shown that electrosurgery gives equal fertility restoration and the expenditure on equipment is far less.2 Also under magnification manipulation of the electrosurgery probe is easier than the laser probe3 and some of the accidental complications of the laser method do not arise. The surgery-conception interval for salpingostomy however seems to be shorter following laser surgery.
Gynaecological disorders in children
Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven in Succeeding in Paediatric Surgery Examinations, 2017
The differential diagnosis of pelvic pain in children and adolescents is gynaeco-logical and non-gynaecological. History and physical examination should guide the investigation and management. In the adolescent age group it is important to consider complications of sexual activity in the differential diagnosis of abdominal pain. An ectopic pregnancy will present with a triad of amenorrhoea, pelvic pain and irregular vaginal bleeding. Rupture of an ectopic pregnancy and development of a haemoperitoneum may result in haemodynamic instability and an acute abdomen. Adolescents may not be aware of pregnancy or may be reluctant to disclose their pregnancy to healthcare providers; therefore, a high index of suspicion is required so as not to miss this diagnosis. Treatment is either surgical or medical. If surgery is indicated, a salpingectomy or salpingostomy is performed via laparoscopy or laparotomy depending on the stability of the patient. Small unruptured ectopics in reliable adolescents may be managed with single-dose methotrexate therapy given intramuscularly.
Prognostic value of hysterosalpingography after salpingostomy in patients with hydrosalpinx
Published in Journal of Obstetrics and Gynaecology, 2023
Wen-Xi Yao, Du-Zhou Zheng, Wei-Feng Liu, Mi-Mi Zhou, Li Liu, Ming-Jin Cai
Salpingostomy is distal tubal plastic surgery to manage hydrosalpinx using scissors, electrosurgery or laser (Gomel and Wang 1994), with the aim of preserving the fallopian tubes and allowing the patient to attempt natural conception. During surgery, the distal tube is incised and opened in the avascular area, and the newly created ostium is sutured back to the mesosalpinx (Ng and Cheong 2019). However, pregnancy rates and outcomes in various reports differ (Gomel 2015). It is admitted that pregnancy rate and outcome are associated with patient age, tubal stage, adhesion stage, the operative technique used and infection by Chlamydia (Audebert and Pouly 2014). In addition, scholars have found that most natural pregnancies after salpingostomy in patients with hydrosalpinx occur within 18 months (Chu et al.2015).
From β-hCG values to counseling in tubal pregnancy: what do women want?
Published in Gynecological Endocrinology, 2019
Lorenzo Sabbioni, Emanuela Carossino, Filiberto Maria Severi, Stefano Luisi
The salpingotomy group, however, had a higher risk of persistent ectopic pregnancy (PEP) compared to salpingectomy while the rate of repeat tubal EP was the same in the two groups [26]. PEP ranges from 3% to 30% when conservative surgery is undertaken, therefore patients must be followed with serial gonadotropin dosages until resolution. A single dose of methotrexate can be used after surgery if needed. As the recent ACOG Practice Bulletin states, salpingectomy should be preferred in women where there is severe tubal damage or bleeding and should also be considered when the contralateral tube appears undamaged. Salpingotomy can be considered when the woman desires future fertility and when the contralateral tube is heavily damaged [18]. Ideal patients for linear salpingotomy are those with EPs localized in the ampulla or infundibulum of the fallopian tube. Salpingectomy becomes inevitable for EPs of the isthmic part of the tubes, for ruptured tubes or for recurrent homolateral EPs. When the pregnancy is in the cornual area of the uterus, it can be treated laparoscopically, however, laparotomy is often required for cornual resection. Subsequent uterine pregnancies following cornual resection should be delivered by Cesarean section [27–29].
Lymphadenectomy in Primary Fallopian Tube Cancer is Associated with Improved Survival
Published in Journal of Investigative Surgery, 2022
Yao Xiao, Yue-xi Liu, Ruo-nan Li, Xing Wei, Qing-miao Wang, Qiu-ying Gu, Hua Linghu
It is difficult to accurately distinguish the origin of the tumor when it is in the advanced stage. As a result, several patients with PFTC are misdiagnosed and treated as EOC, and thus presents a challenge to the comprehensive understanding of PFTC. Recently, the identification of PFTC has increased because of studies that indicate that microscopic intraepithelial lesions might be the origin of serous high-grade carcinomas [6–8]. According to a previous study [9], the incidence of ovarian carcinomas has decreased by 1.7-fold in the last 20 years, while tubal carcinomas have increased more than 10-fold. Based on this, several trials have studied and confirmed the feasibility and significant survival benefits of salpingectomy as a risk-reducing surgery for OC in high-risk women [10,11].
Related Knowledge Centers
- Birth Control
- Ectopic Pregnancy
- Hydrosalpinx
- Infertility
- Laparoscopy
- Laparotomy
- Tubal Ligation
- Cancer
- Fallopian Tube
- Prophylactic Salpingectomy