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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_207_библиотеки_им_акад_М_И_Перельмана
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toward the inside of the tube. The number of sutures required may vary from three to six in order to fully evert all of the
edges. Tubes with significant inflammation may have thicker walls that are more difficult to roll outward. These may need
two to three sutures on each leaflet to keep the edges everted (Tech Figs . 4.2.9 and 4.2.10).
Te ch Fig ure 4.2.9. Tying init ial suture.
Te ch Fig ure 4.2.10. Completed neosalpingostomy aft er placing as many sutures required to maintain patency (five in t his instance).
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Adhesion prevention
Careful dissection with limited trauma and judicious use of electrocautery are key in the prevention of future adhesion
formation. All adhesion barriers have limitations as to their effectiveness, though for this procedure, we prefer to use
Interceed
®
(Ethicon Inc., Somerville, NJ). Use ½ of a standard 3 × 4-in sheet to wrap around the distal portion of the tube
to form a tubal “sock.” The remaining ½ sheet is then used to wrap under the ovary, making an effort to separate the tube
from both the ovary and pelvic sidewalls during the healing process.
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PEARLS AND PITFALLS
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POSTOPERATIVE CARE
The patient can attempt to conceive immediately following surgery. However, if Interceed
®
is placed, this can be expected
to persist for 1 month after surgery (per manufacturer’s insert). A postoperative HSG can be performed if the patient is
unable to conceive within 3 to 4 months following surgery to verify tubal patency. It should be noted that tubal patency does
not necessarily imply tubal function.
If unable to conceive after 6 to 12 months of appropriate timed intercourse, the patient should consider IVF.
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OUTCOMES
Chance of conceiving is related to the severity of tubal damage (based on amount of dilation, thickness of tubal walls, and
presence or absence of viable tubal mucosa) and tubo-ovarian adhesions.
3
Pregnancy rates are very low in patients with a prior history of ectopic pregnancy or prior tubal surgery.
Live birth success rates are approximately 14% to 23% after 1 year, and 20% to 34% after 2 years.
3
Risk of ectopic pregnancy is 10% to 13% following neosalpingostomy. Patients should be cautioned to have close follow-up
after conceiving due to this increased risk.
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COMPLICATIONS
Reclosure of tubal end necessitation repeat surgery with salpingectomy.
Postoperative adhesion formation limiting tubal function.
Ectopic pregnancy after conception.
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KEY REFERENCES
1. Zeyneloglu HB, Arici A, Olive DL. Adverse effects of hydrosalpinx on pregnancy rates after in vitro fertilization–embryo
transfer. Fertil Steril. 1998;70:492–499.
2. Saunders RD, Nakajima ST, Myers J. Experience improves performance of hysterosalpingo-contrast sonography
(HyCoSy): a comprehensive and well-tolerated screening modality for the subfertile patient. Clin Exp Obstet Gynecol.
2013;40(2):203–209.
3. Audebert A, Pouly JL, Bonifacie B, et al. Laparoscopic surgery for distal tubal occlusions: lessons learned from a
historical series of 434 cases. Fertil Steril. 2014;102(4):1203–1208.
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Chapter 4.3
Tubal: Salpingectomy
Travis W. M cCoy
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GENERAL PRINCIPLES
Definition
Salpingectomy involves removal of a fallopian tube due to multiple reasons. These could include desire for sterility; treatment
of ectopic pregnancy; hydrosalpinx; or irreparable damage due to adhesions, endometriosis, or other pelvic pathology.
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IMAGING AND OTHER DIAGNOSTICS
Severe tubal damage may be apparent by hysterosalpingogram (HSG), or by the obvious presence of hydrosalpinx on
ultrasound.
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