TUBOPLASTY

By Joseph Hazan,M.D.,FACOG

 About a third of female infertility is caused by

 tubal factors and endometriosis.

In some cases the tubal problem is

caused by pelvic inflammatory

disease, previous ectopic pregnancy,

obliterative fibrosis, tubal polyps, fibroids,

salpingitis isthmica nodosa ,fimbrial agglutination

or adhesions and hydrosalpinx.

However the most common reason

for tubal infertility is previous

tubal ligation for sterilization.

This could be at the proximal

(close to the uterus), midsegment

(mid-portion) or distal ( the last

third) of the tubes.

Tubal reversal is accomplished by tuboplasty.

Tuboplasty with the use of operating

microscope, loupes results in improved and

precise reapproximation and reanastomosis

of the tubal portions that are undamaged.

Microsurgical reanastomosis has been

successful in most cases with resulting

restoration of fertility in our experience.

In cases where the tubal occlusion is at

the tubocornual segment (the portion

of the tube closest to the uterus),

microsurgical tubocornual reanastomosis

is done.

At the midportion tubal isthmic-isthmic

reanastomosis is done with the greatest

success rate. Tubal isthmic-ampullary

reanastomosis, neosalpingostomy and

fimbrioplasty are performed for more

distant tubal occlusion or obstruction

cases.

Tomorrow we will look at most recent

data on this topic.