Removal of the fallopian tube: what threatens?

Removal of the fallopian tube is an operation that is 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 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 works that prove the opposite point of view. The authors point out that menstrual irregularities, hormonal disruptions and other problems with the female reproductive system occur most often in those patients who have had their fallopian tubes removed.

Indications for the operation

Salpingectomy is a surgical intervention, the purpose of which is 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 for vital indications on an emergency basis. If the patient’s life is not in danger, then tubectomy is planned.

Indications for salpingectomy:

• Growth and development of the embryo in the cavity of the tube. On an emergency basis, the procedure is carried out when the embryo ruptures the appendage and the woman has internal bleeding.

• If an ectopic pregnancy is formed a second time in the same tube.

• Adhesions of the small pelvis that grow into tubes.

• Ectopic pregnancy, which is not subject to conservative therapy (when the diameter of the fetal egg exceeds 30 mm). As for the conservative method of treating ectopic pregnancy, it is implemented in order for the woman to be able to become pregnant on her own in the future. In this case, the fetal egg is pushed into the ampullar part of the tube, or a salpingostomy is applied to it.

• The tube can be removed when the salpingostomy was unsuccessful and complicated by bleeding.

• With severe deformities of the fallopian tube against the background of adnexitis or salpingitis. The tube is removed when its functionality cannot be restored.

• Formation of pyosalpinx (accumulation of pus in the lumen of one or both fallopian tubes).

• Planning for in vitro fertilization. Doctors in some cases insist on the removal of the fallopian tubes, citing the fact that IVF may be ineffective. The fact is that it is possible to reverse the flow of inflammatory exudate from the tubes into the uterine cavity and “wash out” the planted, but not implanted, fetal egg. In addition, if an inflammatory process occurs in the tubes, this can lead to a toxic effect on the embryo. Sometimes it happens that the implanted embryo begins to take root in the uterus, but after some time, due to inflammation in the tubes, a woman has a miscarriage. Therefore, if a patient has hydrosalpinx for six months and she plans IVF, then the doctors insist on the preliminary removal of the fallopian tubes.

• The presence of hydrosalpinx itself, without IVF planning, may be an indication for removal of the fallopian tube. This is especially true for those patients in whom the hydrosalpinx has an impressive size.

• A combination of hysterectomy is possible (the operation is used for pathologies of the uterus, for malignant neoplasms of the ovaries, etc.) and tubectomy.

Most often, the doctor decides on the possibility of removing or preserving the fallopian tubes after or during diagnostic laparoscopy.

How the fallopian tubes are removed: the essence of the procedure

There are two types of fallopian tube surgery: laparoscopy and laparotomy. Laparoscopic intervention is a priority, it has a minimum 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 after it recover quickly enough, and the rehabilitation period itself is much easier than after laparotomy.

If a tube rupture occurs against the background of an ectopic pregnancy, then this process is almost always accompanied by severe bleeding. It is not excluded the development of hemorrhagic shock and other complications, up to death. Therefore, in such a situation, a woman can only do a laparotomy. In parallel, intensive infusion-transfusion therapy will be carried out. Only thanks to the implementation of an emergency operation, it is possible to save a woman’s life.

Stages of laparotomy:

• Introduction of general anesthesia.

• Making an incision: according to Pfannenstiel (transverse incision above the womb) or an incision in the anterior wall of the peritoneum, below the umbilical zone.

• Pumping out blood that has entered the abdominal cavity. The blood is collected in separate vials to be able to transfuse it later. However, autologous blood transfusion is available only if the patient is free of inflammation.

• Extraction of the uterus and appendages in order to find the source of bleeding.

• The imposition of a clamp on the isthmic part of the appendage, as well as on the mesentery. This allows you to stop the bleeding.

• Cut off the fallopian tube.

• Sanitation of the peritoneum and suturing.

During laparoscopy, the surgeon performs similar actions, but the blood pumped out of the peritoneum is not transfused to the woman.

If possible, the pipes are removed not completely, but partially.

Indications for resection of the fallopian tubes:

• The presence of adhesions only in a small area of ​​the fallopian tube.

• An ectopic pregnancy that has just begun to develop.

• A benign tumor in one of the corners 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 for laparoscopy of the fallopian tubes

Laparoscopic method can not remove the fallopian tubes in the presence of the following contraindications:

• 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 the condition that only 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.

When the fallopian tube is completely removed, it will not be possible to restore it.

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 a few days after the operation.

• Bleeding, 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 the hemostasis procedure poorly.

• Nausea and vomiting. These complications are a consequence of the administered anesthesia, or arise as a result of intestinal irritation. The intestine most often “suffers” after laparoscopy, when carbon dioxide is injected into the peritoneum.

• The 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 occur infrequently.

The consequences of the operation

The uterus with the fallopian tubes has common nerve fibers, blood and lymphatic 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 failure is one of the consequences of the operation to remove the fallopian tubes.

Women complain of symptoms such as:

• Headache and dizziness;

• Nervousness, irritability, tearfulness;

• Pain in the region of the heart;

• Increased sweating;

• Congestion of blood to the upper half of the body.

Symptoms tend to intensify before the next menstruation, and they are far from disturbing all women (they are observed in about 42% of cases).

About 35% of patients after 2-3 months after removal of the appendage notice menstrual irregularities. During the passage of 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 is due to a violation of the flow of lymph and blood.

There is also an alternation of normal menstrual cycles with disturbed ones. Perhaps a decrease in the efficiency of the luteal body, the cessation of ovulation. However, such conditions are rarely observed.

From the side of the mammary glands, the following changes occur:

• The glands become engorged in 6% of patients;

• The breast 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;

• It is also possible to develop the following symptoms: weight gain, the appearance of body hair, 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, a woman is shown the introduction of antibiotics, which helps prevent the development of possible inflammation.

To minimize the risk of adhesion formation, the following measures are taken:

• Doctors try to use laparoscopic surgery whenever possible, which is characterized by minimal trauma.

• Before completion of the operation, absorbable barrier gels are introduced into the abdominal cavity. For some time they contribute to the fact that the surfaces of organs are at a distance from each other. This is a measure aimed at preventing adhesion formation.

• The patient was raised the next day after the operation.

• A woman is prescribed physiotherapeutic procedures: electrophoresis with iodine and zinc.

• Calm walking and other moderate exercise can prevent the formation of adhesions, or minimize the risk of their formation.

• 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 contraceptives to prevent pregnancy.

• It is important to properly care for postoperative sutures, which will 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 water does not get into them.

• For a month after the operation, doctors recommend that patients wear slimming underwear.

• Intimacy is under an absolute ban during the first month after the surgery.

• You don’t need to follow 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 a tube has ruptured or a hematosalpinx has been removed. It is not worth considering spotting as a complication of the operation, since they are explained by the reflux of blood into the uterus during the surgical intervention or before it begins.

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 can 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 impressive, then curettage of the uterus and blood transfusion may be required.

Early onset of menstruation after surgery is observed infrequently, in the vast majority of cases, menstruation comes on time. Although sometimes it happens that the cycle is restored for at least two months. This is also not a deviation from the norm. If after 60 days after the operation the cycle has not stabilized, then you need to contact the doctor. It is possible that the operation caused endocrine disorders that require professional correction.

Can you get pregnant without fallopian tubes?

Without fallopian tubes, a woman cannot conceive 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 made back in the 70s of the last century. However, it was not successful, so it did not take root in medicine.

The only method that can help women conceive and bear 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 capture the egg released from the ovary into the abdominal cavity with fimbriae and gradually move it into the uterus. It is also possible for a sperm to meet an egg in the tube and fertilize it. In the peritoneal cavity, the egg is able to exist for two days, after which it dies.

When a woman has one tube missing, the following options are possible:

• Ovulation will not occur, the follicles will begin their reverse development. This situation is most often observed against the background of hormonal failure.

• The egg will go into the abdominal cavity, and after 2 days it will die and be destroyed in it.

• The egg will float in the abdominal cavity, it can reach the tube that has remained intact, and pass through it to the uterus.

Of course, it is much easier for fimbriae to capture the egg that is secreted by the ovary from the side of a healthy tube. If both appendages are removed from a woman, then the ovaries either undergo reverse development, or the egg will constantly die in the peritoneal cavity.

When can I plan to conceive after surgery?

A woman after the removal of one fallopian tube will be able to become pregnant on her own in 56-61% of cases. And it 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 do 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 their former 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 the removal of the fallopian tubes.

Can tubal plasty replace them?

Gynecological surgeons may perform surgery to repair part of the fallopian tube, calling the procedure a fallopian tubeplasty. It is carried out after removal of 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 pipes lose their ability to contract, which means that fertilization will be impossible. Therefore, the operation is carried out only when a small area of ​​​​the appendage needs to be replaced.