1Eddy Hartono
1Department of Obstetrics and Gynecology, Hasanuddin University, Makassar, South Sulawesi, Indonesia Elected International Society for Gynecological Endoscopy (ISGE) Board Member 2017-2021
ABSTRACT
Hydrosalpinx is a fluid-filled distension of the fallopian tube with concurrent distal tubal occlusion.Hydrosalpinxassociated infertility is supposed to be treated only by IVF. Furthermore, salpingectomy plays a crucial role prior to IVF and scientific evidences have shown that it may improve pregnancy outcomes compared to functional surgery by removing the toxic effects of hydrosalpinx. However, functional surgery may be the excellent option in developing countries or in cases with specific characteristics. Functional surgery (i.e. fimbrioplasty, salpingostomy, microsurgical tubocornual anastomosis) may be amenable to performed in hydrosalpinges. Fimbioplasty, salpingostomy, and microsurgical tubocornual anastomosis may increase pregnancy rate by 53%, 30%, and 80% respectively. Thin-walled hydrosalpinges with mucosal adhesions had a higher rate of tubal pregnancy, whereas thick-walled hydrosalpinges with fibrosis of the wall were not compatible with normal pregnancy. Functional surgery is, therefore, indicated in patients with thin-walled hydrosalpinges with minimal or no mucosal adhesions.Studies have shown that laparoscopic salpingectomy improves IVF outcomes. It should be performed only when hydrosalpinges are unable to be repaired or in cases of IVF failure. Functional tubal surgery should be preferred to salpingectomy in milder forms of tubal disease or in developing countries. Proper assessment of tubal mucosa of hydrosalpinges should be performed prior to surgical treatment as this will prevent mis-management of patients.
KEY-WORDSHydrosalpinx, Tubal Surgery, IVF
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VOLUME 02 ISSUE 02 NOVEMBER 2019
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