adam magos

Damage to the fallopian tubes, usually caused by infection or previous surgery (e.g. appendicectomy), can be associated with adhesions around the tubes, and in more severe cases, tubal blockage and distension (hydrosalpinx). Laparoscopic surgery can be used to divide peri-tubular adhesions in an attempt to normalise the normal relationship between the fallopian tube and ovary, and to open up the blocked tubes as long as the blockage involves the distal (fimbrial) end. Infertility is the main indication for this type of surgery, and studies have shown that adhesiolysis improves the pregnancy rate three-fold, whereas the overall pregnancy rate after salpingostomy or fimbrioplasty (for distal blockage) is in the range of 30% to 60% respectively. Unfortunately, these procedures do not only increase the rate of normally sited intra-uterine pregnancies, but also increase the risk of ectopic pregnancy (a pregnancy which implants outside the cavity of the womb, and which then has to be removed).

In fact, laparoscopic surgery is also the "gold standard" surgical technique for treating ectopic pregnancies, involving either removal of the pregnancy with conservation of the fallopian tube (salpingotomy), or removal of both the pregnancy and tube (salpingectomy). Salpingectomy is sometimes also done for symptoms of pelvic pain if damaged fallopian tubes are thought to be responsible, as an alternative to the use of clips for female sterilisation, and to improve the outcome of IVF in women with hydrosalpinges.