 |
 |
|
Microsurgery entails the use of the following surgical techniques:
The microsurgery operation may take from 1 to 4 hours. Depending on the extent of pelvic damage it is usually done under spinal or general anesthesia. The incision used is usually a "bikini cut" (Pfannensteil incision). The length of stay in hospital is usually three to seven days. Tubal microsurgery can be expensive and may cost up to Rs.40,000. Sometimes a "check or second-look laparoscopy " is performed about one week after surgery to ensure that tubal patency is maintained and to remove any small adhesions that may have started to re-form.
The tubal obstruction could be at the uterotubal junction and this is called a cornual block. The conventional surgical repair of cornual blocks involved reimplanting the tube into the uterus and had dismal success rates. However, with microsurgery, it is possible to see the very fine ends of the tubes under high magnification and to join them together. This has a pregnancy rate of about 50%, since the function of the rest of the tube is basically intact.
Recently, doctors have realized that a number of patients have cornual blocks because of the presence of mucus plugs and debris in the very fine cornual segment of the tubes. Newer non-surgical methods have now been devised to treat this. These involve the passage of a fine guide wire or a fine balloon into the cornual end of the tube through the uterus. This is called a "balloon tuboplasty" or "cornual recanalisation," and can be done under ultrasound guidance; hysteroscopic guidance, or fluoroscopic (X-ray) guidance. This is a significant advance, since it saves patients the need for major surgery, and also has excellent pregnancy rates.
This procedure entails division of adhesions surrounding the tubes. When no other damage is apparent, success rates may be as high as 65%.
These include a variety of procedures that involve removing the damaged portion of the tubes and rejoining the healthy ends of the tube together. Success rates vary according to the area of damage but are usually within the range of 20 - 50 percent. The chances of success are higher when the defect occurs in the middle section of the tube.
© Dr. Aniruddha Malpani and Dr. Anjali Malpani www.drmalpani.com
Credits: How to Have a Baby: Overcoming Infertility
