Removal of the fallopian tube: what is the threat?
Removal of the fallopian tube is an operation performed by many women at different ages. Sometimes doctors have to cut one, and sometimes two tubes at once. Statistics indicate that from 3 to 12% of women go through the procedure for removing the appendages.
The general condition of the body, according to some experts, is not disturbed, because the fallopian tubes are only a transport system for the egg and sperm.
However, there are a number of scientific papers that prove the opposite point of view. The authors point out that irregularities in the menstrual cycle, hormonal disruptions and other problems with the female reproductive system occur most often in those patients who underwent removal of the fallopian tubes.
Content:
- Indications for the operation
- How the fallopian tubes are removed: the essence of the procedure
- Contraindications to laparoscopy of the fallopian tubes
- Is it possible to restore the pipe after removal?
- Complications after removal of the fallopian tubes
- The consequences of the operation
- Rehabilitation
- Can you get pregnant without the fallopian tubes?
- If there is no fallopian tube, where does the egg go?
- When can I plan to conceive after surgery?
- Is plastic of the fallopian tubes able to replace them?
Indications for the operation
Salpingectomy is a surgical procedure to remove the fallopian tube. Another name for the procedure is tubectomy. During its implementation, one or both appendages are removed. The procedure can be carried out on a vital basis on an emergency basis. If nothing threatens the patient's life, then the tubectomy is planned.
Indications for salpingectomy:
- The growth and development of the embryo in the tube cavity. On an emergency basis, the procedure is carried out when the embryo ruptures the appendage and the woman opens up internal bleeding.
- If an ectopic pregnancy is formed in the same tube for the second time.
- Pelvic adhesions that grow into the tubes.
- Ectopic pregnancy, which is not subject to conservative therapy (when the diameter of the ovum exceeds 30 mm). As for the conservative method of treating an ectopic pregnancy, it is implemented in order for a woman to become pregnant on her own in the future. In this case, the ovum is pushed into the ampullar part of the tube, or a salpingostomy is applied to it.
- The tube may be removed if the salpingostomy was unsuccessful and complicated by bleeding.
- With pronounced deformities of the fallopian tube against the background of adnexitis or salpingitis. The pipe is removed when its functionality cannot be restored.
- Formation of pyosalpinx (accumulation of pus in the lumen of one or both fallopian tubes).
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In vitro fertilization planning. In some cases, doctors insist on the removal of the fallopian tubes, arguing that IVF may be ineffective. The fact is that the reverse flow of inflammatory exudate from the tubes into the uterine cavity and "washing out" of the planted, but not implanted ovum is possible. In addition, if an inflammatory process occurs in the tubes, then this can lead to toxic effects on the embryo. Sometimes it happens that the implanted embryo begins to take root in the uterus, but after a while, due to inflammation in the tubes, the woman has a miscarriage. Therefore, if a patient has a hydrosalpinx for six months and she plans IVF, then the doctors insist on the preliminary removal of the fallopian tubes.
- The presence of a hydrosalpinx in itself, without IVF planning, may be an indication for the removal of the fallopian tube. This is especially true for those patients in whom the hydrosalpinx is impressive in size.
- A combination of hysterectomy (the operation is used for pathologies of the uterus, for malignant neoplasms of the ovaries, etc.) and tubectomy is possible.
Most often, the doctor decides whether to remove or save the fallopian tubes after or during diagnostic laparoscopy.
How the fallopian tubes are removed: the essence of the procedure
There are two types of operations to remove the fallopian tubes: laparoscopy and laparotomy. Laparoscopic intervention is a priority, it has a minimal set of contraindications, does not require extensive incisions to gain access to the fallopian tubes, and does not injure tissues and organs. In addition, patients recover quickly after it, and the rehabilitation period itself is much easier than after a laparotomy.
If there is a rupture of the tube against the background of an ectopic pregnancy, then this process is almost always accompanied by severe bleeding. The development of hemorrhagic shock and other complications, including death, is not excluded. Therefore, in such a situation, a woman can only have a laparotomy. At the same time, intensive infusion-transfusion therapy will be carried out. Only by performing an emergency operation is it possible to save a woman's life.
Stages of laparotomy:
- Introduction of general anesthesia.
- Execution of the incision: according to Pfannenstiel (transverse incision above the bosom) or incision of the anterior wall of the peritoneum, below the umbilical zone.
- Pumping blood that has entered the abdominal cavity. Blood is collected in separate vials to be able to be transfused later. However, transfusion of autologous blood is available only if the patient does not have inflammation.
- Removal of the uterus and appendages in order to find the source of bleeding.
- Clamping the isthmic part of the epididymis, as well as the mesentery. This stops the bleeding.
- Cutting off the fallopian tube.
- Sanitation of the peritoneum and suturing.
During laparoscopy, the surgeon performs the same steps, but the blood drawn from the peritoneum is not transfused to the woman.
If possible, the pipes are not completely removed, but partially.
Indications for resection of fallopian tubes:
- The presence of adhesions only in a small area of the fallopian tube.
- An ectopic pregnancy that has just begun its development.
- A benign tumor in one corner of the uterus.
The decision on whether it is possible to remove only part of the fallopian tube is made on an individual basis.
Contraindications to laparoscopy of the fallopian tubes
The laparoscopic method should not remove the fallopian tubes if the following contraindications are present:
- Peritonitis.
- Rupture of the fallopian tube, accompanied by severe bleeding.
- Myocardial infarction, stroke.
- Cancer of the uterus and appendages.
- Obesity 3 and 4 degrees.
- Diabetes mellitus in the stage of decompensation.
In the presence of these contraindications, the woman undergoes laparotomy removal of the appendages.
Is it possible to restore the pipe after removal?
There is a possibility of plastic surgery of the fallopian tube, but only on condition that only a part of it has been removed. The procedure is performed if the doctor sees that the woman will have the opportunity to become pregnant naturally in the future.
Once the fallopian tube has been completely removed, it cannot be restored.
Complications after removal of the fallopian tubes
Among the possible complications after removal of the fallopian tube, the most significant are the following:
- Development of inflammation. It is accompanied by an increase in body temperature immediately or several days after the operation.
- Bleeding, the formation of hematomas in the peritoneal cavity, or in the thickness of the subcutaneous fatty tissue. Hematomas indicate that the woman has problems with blood clotting, or the surgeon performed poorly in the procedure of hemostasis.
- Nausea and vomiting. These complications are a consequence of the administered anesthesia, or result from intestinal irritation. The intestine most often "suffers" after laparoscopy, when carbon dioxide is injected into the peritoneum.
- Formation of adhesions that can disrupt the work of all internal organs. Moreover, there is a risk of their formation both after laparoscopy and after laparotomy.
It should be understood that the above complications are infrequent.
The consequences of the operation
The uterus with the fallopian tubes has common nerve fibers, blood and lymph vessels. In addition, the state of the mammary glands and the neuroendocrine system as a whole depends on their work. Therefore, the violation of these connections negatively affects the work of the adrenal glands and the thyroid gland.
Hormonal disruption is one of the consequences of an operation to remove the fallopian tubes.
Women complain of symptoms such as:
- Headaches and dizziness;
- Nervousness, irritability, tearfulness;
- Painful sensations in the region of the heart;
- Increased sweating;
- Flushing of the upper half of the body.
Symptoms tend to intensify before the next menstruation, and they do not bother all women (observed in about 42% of cases).
Another 35% of patients, 2-3 months after removal of the epididymis, notice menstrual irregularities. During the ultrasound, they are diagnosed with an increase in the size of the ovary on the side where the fallopian tube was removed. Over time, it undergoes sclerotic changes, which are caused by a violation of the flow of lymph and blood.
There is also an alternation of normal menstrual cycles with disturbed ones. Possible decrease in the performance of the luteal body, cessation of ovulation. However, such conditions are rare.
On the part of the mammary glands, the following changes occur:
- The glands are rough in 6% of patients;
- The chest becomes larger due to diffuse expansion of the lobules in 15% of patients;
- The thyroid gland increases in size, its work is disrupted in 26% of patients;
- The development of the following symptoms is also possible: gaining excess weight, the appearance of hair on the body, the formation of stretch marks on the skin.
These symptoms are especially pronounced in those women who have undergone surgery to remove both appendages.
Rehabilitation
In the early rehabilitation period, the woman is shown the introduction of antibiotics, which allows to prevent the development of possible inflammation.
To minimize the risk of adhesion formation, the following measures are taken:
- Doctors try, whenever possible, to use a laparoscopic operation, which is characterized by minimal trauma.
- Before the end of the operation, absorbable barrier gels are injected into the abdominal cavity. For some time, they contribute to the fact that the surfaces of the organs are at a distance from each other. This is a measure aimed at the prevention of adhesions.
- After the operation, the patient is raised the very next day.
- A woman is prescribed physiotherapy procedures: electrophoresis with iodine and zinc.
- Calm walking and other moderate loads prevent the formation of adhesions, or reduce the risk of their formation to a minimum.
- After the operation, the woman is prescribed a course of antibiotics, subcutaneous injections of aloe extract are made for 14 days. Perhaps the appointment of vaginal suppositories Longidaza.
- For 6 months after the removal of the fallopian tubes, it is imperative to take contraceptive pills to prevent pregnancy.
- It is important to properly care for the postoperative sutures to prevent their inflammation. You need to refuse to take a bath, you should wash yourself in the shower. In this case, the seams must be closed so that no water gets into them.
- For a month after the operation, doctors recommend that patients wear slimming underwear.
- Intimacy is absolutely prohibited during the first month after the operation.
- You do not need to adhere to any special diet. However, you should temporarily exclude from your menu products that increase gas formation in the intestines. Therefore, you need to give up legumes, whole milk, yeast baked goods and pastries, cereals, meat and carbonated drinks.
After the operation, a woman may experience bloody discharge from the vagina for several days. This is normal, especially when the tube has ruptured or the hematosalpinx has been removed. It is not worth considering spotting as a complication of the operation, since it is explained by the flow of blood into the uterus during or before the operation.
If the body quickly adapted, or there was a hormonal failure against the background of an existing disease, then a few days after the removal of the appendages, the woman may begin another menstruation. Moreover, this cycle may be longer than all previous ones. With minor blood loss, characteristic of standard menstrual bleeding, you should not worry about this. If the blood loss is significant, then uterine curettage and blood transfusion may be required.
The early onset of menstruation after surgery is rare, in the vast majority of cases, menstruation comes on time. Although it sometimes happens that the cycle is restored for at least two months. This is also not a deviation from the norm. If, 60 days after the operation, the cycle has not stabilized, then you need to consult a doctor. It is possible that the operation resulted in endocrine disorders that require professional correction.
Can you get pregnant without the fallopian tubes?
Without the fallopian tubes, a woman cannot get pregnant naturally. At the moment, doctors have not been able to develop an analogue of the fallopian tubes, although they have been trying to make them for many years. The first attempt to implant artificial appendages was carried out in the 70s of the last century. However, it was not crowned with success, so it did not take root in medicine.
The only method that can help women conceive and carry a child without both fallopian tubes is in vitro fertilization.
If there is no fallopian tube, where does the egg go?
When both fallopian tubes are in place, they fimbria capture the ovum released from the ovary into the abdominal cavity, and gradually move it into the uterus. Also in the tube, a meeting of a sperm with an egg and its fertilization is possible. In the peritoneal cavity, the egg is able to exist for two days, after which it dies.
When a woman has one pipe missing, the following options are possible:
- Ovulation will not occur, the follicles will begin their reverse development. A similar situation is most often observed against the background of hormonal disruption.
- The egg cell will go out into the abdominal cavity, and after 2 days it will die and be destroyed in it.
- The ovum will float along the abdominal cavity, can reach the tube that has remained intact, and pass through it into the uterus.
Of course, it is much easier for fimbriae to capture the egg that is secreted by the ovary from the side of the healthy tube. If both appendages are removed in a woman, then the ovaries either undergo reverse development, or the egg cell will constantly die in the peritoneal cavity.
When can I plan to conceive after surgery?
A woman, after removing one fallopian tube, will be able to become pregnant on her own in 56-61% of cases. Moreover, this does not depend on the type of surgical intervention. Doctors point out that it is necessary to plan a pregnancy no earlier than six months after the operation. A number of experts generally recommend that a woman wait 1-2 years while taking oral contraceptives. During this time, it will be possible to normalize the work of the neuroendocrine system and the body will be ready to bear the child.
After removal of the fallopian tubes, 42% of patients develop infertility, and in 40% of cases, the ovaries stop working with the same strength. Moreover, the risk of developing an ectopic pregnancy is 10 times higher. Therefore, IVF is the only method that allows a woman to conceive a child after removing the fallopian tubes.
Is plastic of the fallopian tubes able to replace them?
Gynecological surgeons can perform surgery to repair part of the fallopian tube, calling this procedure fallopian tube repair. It is carried out after removing the deformed portion of the appendage.
As for the complete restoration of the fallopian tubes, this operation is not advisable. The fact is that a woman's own appendages have the ability to contract so that the egg can move along them and reach the uterus. After plastic surgery, the tubes lose their ability to contract, which means that fertilization will be impossible. Therefore, the operation is performed only when it is necessary to replace a small part of the appendage.
The author of the article: Lapikova Valentina Vladimirovna | Gynecologist, reproductologist
Education: Diploma in Obstetrics and Gynecology received at the Russian State Medical University of the Federal Agency for Healthcare and Social Development (2010). In 2013 completed postgraduate studies at N. N. N. I. Pirogova.
