Unilateral Salpingectomy

Overview

The surgical removal of one or both fallopian tubes is known as a salpingectomy. Getting pregnant is frequently more difficult after this operation. A salpingectomy may be performed for a variety of reasons, including the prevention of ovarian cancer, ectopic pregnancy, tubal obstruction, or infection. If you do not want to become pregnant, it can also permanently prevent it. If you are at a higher risk of getting ovarian cancer, your doctor may advise you to have a salpingectomy as a preventative.

Salpingectomy carries the same dangers as any other operation, including infection, damage to the surrounding region, uncontrolled bleeding, unexpected response to anesthesia, and blood clots.

Salpingectomy cures specific medical issues and helps to avoid ovarian cancer in women who are predisposed to it. The major advantage of the operation is that it relieves symptoms caused by fallopian tube disorders and lowers your chance of acquiring cancer. A salpingectomy can also provide permanent contraception, ensuring that you never become pregnant again.

If you have an open abdominal salpingectomy or other surgeries, your recovery time will be prolonged. A slower recovery period of four to six weeks is to be expected. This is due to the fact that your incision site may be uncomfortable or unpleasant, making it difficult to resume your typical activities. Consult your healthcare practitioner about any changes you should make throughout your recuperation.

What is Salpingectomy?

A salpingectomy is a surgical operation that removes one or both of your fallopian tubes. When conception occurs, the fallopian tubes transport the egg to the uterus. Your fallopian tubes are situated on top and on each side of your uterus, almost like a pair of horns.

A unilateral salpingectomy is when only one fallopian tube is removed. However, removing both fallopian tubes is known as bilateral salpingectomy. To shorten healing time, a salpingectomy can be done laparoscopically. Salpingostomy is different and it's the formation of a hole in the fallopian tube, although the tube itself is not removed.

Due to the danger of ectopic pregnancies, this operation is now occasionally recommended over its ovarian tube-sparing equivalents. This surgery is irreversible and more successful than tubal ligation for contraception.

Who Gets Salpingectomy?

A salpingectomy is performed to treat certain medical issues like:

Ectopic pregnancy:

A fertilized egg is the starting point for a pregnancy. Normally, the fertilized egg adheres to the uterine lining. When a fertilized egg implants and develops outside the main cavity of the uterus, it is called an ectopic pregnancy.

Ectopic pregnancy is most commonly found in a fallopian tube, which transports eggs from the ovaries to the uterus. A tubal pregnancy is a form of ectopic pregnancy. Ectopic pregnancy can also develop in other parts of the body, such as the ovary, abdominal cavity, or the bottom section of the uterus (cervix), which attaches to the vagina.

An ectopic pregnancy cannot be carried out normally. If left untreated, the fertilized egg cannot survive, and the developing tissue may cause life-threatening hemorrhage.

Unilateral salpingectomy is a radical method that eliminates the danger of residual trophoblast and lowers the chance of recurrent tubal pregnancy, but it leaves only one tube for reproductive potential.

Cancer of the uterus, ovaries, or fallopian tubes:

The removal of the fallopian tubes for the primary prevention of ovarian cancer in a woman who is already having pelvic surgery for another reason is known as opportunistic salpingectomy.

The American College of Obstetricians and Gynecologists accepts the following recommendations and conclusions based on current knowledge of ovarian carcinogenesis and the safety of salpingectomy:

• When compared to hysterectomy alone or tubal ligation, salpingectomy at the time of hysterectomy or as a method of tubal sterilization appears to be safe and does not increase the risk of complications such as blood transfusions, readmissions, and postoperative problems, infections, or fever.
• Informed consent discussions on the role of oophorectomy and bilateral salpingo-oophorectomy should be included in counseling women having regular pelvic surgery about the risks and benefits of salpingectomy.
• Patients who want permanent sterilization should be informed about the dangers and advantages of salpingectomy.

Infection in the fallopian tubes:

A tubal infection causes scarring or obstruction of the fallopian tubes, which might be irreversible. They may expand to produce Hydrosalpinx (a condition where the fallopian tube gets blocked with a watery fluid). The transport of sperm to the egg will be impeded, resulting in infertility.

If there is an abscess in the fallopian tubes or ovaries, a laparoscopic operation can be performed to remove the fluid. The fluid-filled region can also be removed during the unilateral salpingectomy technique.

Endometriosis in the fallopian tubes:

The difficulty is that this tissue behaves like regular endometrial tissue in that it develops up and breaks down with your menstrual cycle, yet it cannot be shed during your period like normal endometrial tissue. As a result, the rogue tissue irritates and inflames the surrounding tissue.

This tissue accumulation can prevent eggs from escaping the ovaries or being fertilized by sperm. It can also scar and block the fallopian tubes, making it impossible for the egg and sperm to meet. Unilateral Salpingectomy may be recommended in extreme situations.

Blocked or damaged fallopian tubes:

Scar tissue or pelvic adhesions commonly obstruct the fallopian tubes. Many things can contribute to this, including inflammation of the cervix, endometriosis, STIs-sexually transmitted infections- (Chlamydia and gonorrhea can cause scarring and lead to pelvic inflammatory disease), ectopic pregnancy in the past, fibroids (These growths can block the fallopian tube, particularly where they attach to the uterus.) and past abdominal surgery, particularly on the fallopian tubes, might result in pelvic adhesions that obstruct the tubes.

Types of Salpingectomy

The four types of salpingectomy are:

Unilateral salpingectomy: Only one fallopian tube is removed. This means you may still become pregnant since you still have one working fallopian tube.

Bilateral salpingectomy: This is when both fallopian tubes are removed. You wouldn't be able to get pregnant naturally, but IVF (In Vitro Fertilization) is an option if you wish to become pregnant and still have a uterus.

Partial salpingectomy: Partial salpingectomy is excision of the affected part of an ectopic pregnancy leaving the proximal and distal parts of fallopian tubes away from the ectopic swelling.

Complete or Total Salpingectomy: where the entire fallopian tube is removed.

It is appropriate to conduct either a partial or entire bilateral salpingectomy for sterilizing purposes. If the procedure is required due to a medical problem, the entire fallopian tube is usually removed.

Pre-operative Tests done Before Salpingectomy?

Prior to salpingectomy, tests are done to diagnose and confirm the underlying disease condition. These include:

Abdominal and Pelvic Ultrasound: An abdominal ultrasound is frequently used to determine the underlying problem. A gel is put to the abdomen and a probe is passed over it during the ultrasound. Images are acquired and shown on a screen. The technique is absolutely painless and is performed as an outpatient surgery.

Hysterosalpingogram: During this test, a syringe is used to infuse contrast material (also known as a dye) into the uterus via the vaginal passage. The contrast enters the abdomen via the uterus and the fallopian tube, which may be seen using imaging testing. If the fallopian tube is obstructed, the contrast cannot travel through the tube on that side, resulting in a small region on the x-ray.

Diagnostic Laparoscopy: Laparoscopy is occasionally performed to diagnose a condition by directly seeing the fallopian tubes and other abdominal tissues.

Routine Tests: Routine tests which are done before any surgery include:

• Blood tests like hemoglobin levels, blood group, electrolytes and kidney function tests.
• Routine urine test.
• ECG to study the electrical activity of the heart before anesthesia to make sure that the patient is fit prior to the surgery.
• Chest x-ray to rule out infection in the chest before anesthesia.

In older group of patients, detailed assessment of the heart may be required to make sure that they are fit for surgery and undergo an anesthesia.

What is the Procedure for Salpingectomy?

Salpingectomy may be done as an open procedure or through a laparoscope.

Type of Anesthesia: Salpingectomy is performed under general anesthesia and, in rare cases, regional anesthesia by injecting a numbing agent into the back to numb the spinal nerves. You will be unconscious during the procedure if you are under general anesthesia and will be unaware of what is going on.

Pre-operative Check-up: The above-mentioned routine tests are ordered a few days before the procedure. A day before the procedure, admission is typically necessary. An enema is occasionally given the day before surgery, either in the afternoon or evening. Some units may prefer to administer laxative pills the night before.

Fasting before Surgery: Overnight fasting is essential, and intravenous fluid may be required on occasion to keep you hydrated. Sedation is sometimes necessary for a decent night's sleep prior to surgery.

Shift from the ward or room to the waiting area in the operating room: An hour or two before the surgery, you will be shifted to the operating room waiting area on a trolley. Once the surgical room is ready, you will be shifted to the operating room.

Shift to the Operating Room: The environment in the operating room can be intimidating at times, and a tiny quantity of sedation might help you overcome your fear. You will be transferred from the trolley to the operation table. When you glance up, you will notice the operating light console and the anesthetic machine at the head end. Monitors for oxygen levels, ECG, and other vital metrics may also be included. The monitors may emit a continual beeping sound, which can be bothersome at times.

Anesthesia before Surgery: If you need general anesthesia, the anesthesiologist will administer medicines through an intravenous line and have you breath gases through a mask to put you to sleep. Once you've fallen asleep, a tube will be put into your mouth and windpipe to provide anesthetic gases to alleviate discomfort and keep you comfortable. An injection will be given into your lower spinal column if you are getting regional anesthesia.

The Salpingectomy Procedure:

There are two types of salpingectomy surgical methods:

• Laparoscopic salpingectomy: A minimally invasive surgery performed with the use of a laparoscope, a thin device having a light and camera at the end. It is implanted by a tiny incision in the abdomen. Your abdomen is next inflated with gas, allowing the surgeon to examine your uterus and fallopian tubes in more detail. Finally, surgical instruments are placed into your belly through additional tiny incisions to remove the fallopian tubes. Your surgeon will seal the wounds with stitches or medical glue after removing excess blood and fluid.

• Open abdominal salpingectomy: Across your abdomen, a huge incision is created (called a laparotomy). Through this incision, your surgeon will be able to reach your fallopian tubes. After your surgeon has removed the fallopian tubes, the wound will be stitched or stapled closed.

A laparoscopic method is favored because it is less intrusive, has a shorter recovery period, and is less likely to result in problems. However, depending on other conditions, an open approach may be required.

Recovery after the procedure

Waking up from General Anesthesia - After the procedure, you will be awakened and the tube into your windpipe will be withdrawn. Before the tube is withdrawn, you will be requested to open your eyes. You will be sedated, and the anesthetist's speech may be weak. When the tube is removed, you may have a cough and, in some cases, nausea.

To keep the stomach empty, a tube called a nasogastric or Ryle's tube may be inserted. An intravenous line will also be present. You will continue to rely on oxygen. When you are completely awake, you will be transferred to the recovery room on a trolley.

Recovery Room - In the recovery room, a nurse will monitor your vitals and observe you for an hour or two before shifting you to the room or a ward.

Post-operative Recovery - Following the procedure, you will be admitted to the hospital for a few days. Laparoscopic surgery promotes a quicker recovery period and, as a result, a shorter length of stay. Following the procedure, light meals may be permitted.

Chest physiotherapy may be initiated after 24 hours to avoid chest infection.If the salpingectomy was performed due to a ruptured pregnancy, you may need to spend the night in an Intensive Care Unit. A blood transfusion may be necessary as well.

DVT Prophylaxis - Early leg mobility and mobilization helps to avoid DVT, or deep vein thrombosis, which occurs when a clot forms in the deep veins of the legs. The clot might spread to the lungs and be lethal. Other precautions, such as a low dosage of heparin and special stockings, may be taken.

Analgesia - Depending on the severity of the pain, medication may be provided. To avoid infection, a few antibiotic injections may be administered intravenously.

Can I get pregnant after a salpingectomy?

It is determined by the type of salpingectomy performed. If you undergo a unilateral salpingectomy (just one fallopian tube is removed), you will be able to conceive as long as the other fallopian tube is still functional. You will be unable to conceive naturally if both fallopian tubes are removed (bilateral salpingectomy).

You can have an IVF (In Vitro Fertilization) pregnancy if you've undergone a salpingectomy. IVF is a procedure that includes fertilizing your eggs in a laboratory and then transferring them to your uterus.

The success rate of IVF is determined on your age as well as other health issues. However, one research found minimal difference in IVF success rates between persons who underwent salpingectomies and those who did not.

When should you contact your doctor?

If you've had one or both of your fallopian tubes removed, you should watch for these signs:

• Fever or chills.
• Swelling or redness at the incision.
• Leaking fluid or pus from the incision.
• Painful urination
• Pelvic pain.
• Swelling or pain in your legs (a sign of blood clots).

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Conclusion

The surgical removal of one (unilateral) or both (bilateral) fallopian tubes is known as a salpingectomy. The fallopian tubes transport eggs from the ovaries to the uterus. Salpingostomy (or neosalpingostomy) is another operation in which the surgeon opens an incision in the fallopian tube to remove its contents. The tube is not taken out. Salpingectomy can be performed alone or in conjunction with other surgeries. Oophorectomy, hysterectomy, and cesarean section are examples of these procedures (C-section).

Salpingectomy can be done to treat a wide range of conditions. If you have an ectopic pregnancy, a blocked fallopian tube, a ruptured fallopian tube, a tubal infection, a fallopian tube, or ovarian cancer, your doctor may recommend it.

After surgery, you’ll go to the recovery room for monitoring. It will take some time to fully wake from the anesthesia. You might have some nausea as well as soreness and mild pain around the incisions.

If you had outpatient surgery, you won’t be released until you can stand up and have emptied your bladder.

Follow your doctor’s recommendations for resuming normal activities. It may take only a few days, but it’s possible it could be longer. Avoid heavy lifting or strenuous exercise for at least a week.

Complications that may follow the procedure include bleeding, infection, chronic pain , other organs injuries and also the complications of anaesthesia.