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Capsule 11 – Laparoscopic management of hydrosalpinx

موضوع مهم اوى … و رخم جدا … و الكلام فيه متضارب .

‎خد بالك من الآتى :

١ – يعنى ايه Hydrosalpinx ؟؟

Salpingitis with watery exudate inside + occlusion of fimbria : swelling of the tube with fluid inside.

٢- مشكلته ايه ؟؟

– Infertility if bilateral.
– This fluid is embryo-toxic passing to the cavity of the uterus : abortion /failed implantation in ICSI.
– Pain : due to the hydrosalpinx itself or surrounding adhesions.

٣-اشخصه ازاى ؟؟

– HSG : dilatation of the tube with no spillage
– TVS : if large : adnexal swelling , mostly sausage shaped , if too large may be multilocular (Some cases watery warm vaginal discharge with no offensive odour …. Then US become free)

٤- اعمله ايه بالمنظار ؟؟
Salpingectomy VS tubal disconnection
موضوع شائك و فيه اختلاف آراء … بس معظم الاّراء بتقول :

– Salpingectomy will decrease the ovarian reserve subsequently due to affection of blood supply of the ovary.
– Salpingectomy is better for pain.
SO :
If infertility only : tubal disconnection.
Pain only : salpingectomy.
Pain & infertility: individualize the management.

‏٥- Salpingectomy : اقرا الكبسولة الى فاتت

– Total salpingectomy flush with uterus.
– Bipolar or higher (never monopolar).
– COMPLETE ADHESEOLYSIS before you start , at least all around the affected tube , why? To prevent direct or thermal injuries to the surroundings.

‏٦- Tubal Disconnection :

– At the junction of the tube with the uterus
– Bipolar is better of course ( but myriland monopolar May be used)
– You MUST identify anatomy , ensure it is the tube … in distorted anatomy you may attack the round ligament or ovarian ligament …
– SO : you MUST do ADHESEOLYSIS around the Cornu at least , identify the three structures then attack the tube

٧- By the way :

There is nothing called hysteroscopic tubal disconnection …. by hysteroscopy you can only insert ESSURE …. & of course it is controversial & too expensive …

مع احترامى … تلسع حوالين ال Ostia و تمشى … ده مَش كلام علمى ….

If you perform HSG after … most cases has intact lumen …

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