Considerations in distal tubal obstruction

Abstract

Turbal surgery involving the terminal end of the fallopian tube can range from lysing adhesions to improve the anatomic relationship between the tube and ovary to salpingostomy, in which a new ostium is created in a badly damage tube. The success of surgery involving the fimbriated end of the tube will be dependent on many factors, most of which are 1) the degree of damage to the fallopian tube, 2) the age of the woman, and 3) the technique of the surgical repair. It is evident that the surgeon has no control over the first two factors, which will significantly impact the success rate. It is important to correctly classify diseases of the distal tube because of the great variation in prognosis; this is inversely proportional to the degree of damage to the fimbria, i.e., the more damage, the worse the prognosis. Some patients have shown a significantly better prognosis. Some patients have shown a significantly better prognosis if rugae are seen in the fimbria of blocked tubes on HSG. The size of a hydrosalpinx tends to be directly proportional to the degree of damage to the fimbria; therefore, the prognosis for salpingostomies is better for a small hydrosalpinx compared with a large hydrosalpinx. Thus, it is important to correctly classify diseases involving the fimbriated end of the fallopian tube to give patients a realistic prognosis.