Laparoscopic surgery for correction of tubal-peritoneal infertility (hydrosalpinx, pyosalpinx)

Tubo-peritoneal infertility, arising from conditions such as hydrosalpinx and pyosalpinx, is one of the most common causes of female infertility. Due to the accumulation of fluid (hydrosalpinx) or pus (pyosalpinx), the fallopian tubes become obstructed, making pregnancy nearly impossible. Specialists at the "Dobrobut" medical network provide comprehensive infertility treatment using the most effective methods of laparoscopic surgery as well as assisted reproductive technologies.

Causes of Hydrosalpinx and Pyosalpinx

Hydrosalpinx:

The accumulation of inflammatory exudate in the fallopian tube can result from several factors:

• Inflammatory diseases of the pelvic organs (PID), including those caused by gonorrhea and chlamydia.
• Endometriosis, where endometrial tissue (the inner lining of the uterus) grows into the fallopian tubes.
• Previous pelvic or abdominal surgeries that may lead to adhesion formation.

Pyosalpinx refers to the presence of pus in the fallopian tube, which accumulates due to severe infection or chronic inflammation of the pelvic organs.

When Surgery Is Necessary

A physician may recommend surgical treatment in cases where conservative therapy is ineffective, specifically:

• diagnosed tubal obstruction causing infertility, which produces symptoms such as chronic pelvic pain;
• deterioration of the prognosis for IVF (implantation possibilities) due to hydrosalpinx;
• development of pyosalpinx requiring urgent intervention to prevent further complications, such as abscess formation or generalized infection.

Indications and Contraindications for Laparoscopic Treatment of Tubal Infertility

Indications:

• Infertility associated with hydrosalpinx or pyosalpinx;
• Recurrent ectopic pregnancies related to fallopian tube pathologies;
• Persistent pelvic pain due to pathological changes in the tubes;
• Failed attempts at assisted reproduction directly related to tubal factors.

Contraindications:

• Severe cardiovascular diseases with high risk;
• Acute infections of the pelvic organs;
• Significant adhesions or deformities that make laparoscopic access unsafe or impossible;
• Blood clotting disorders.

Preparation

Before surgery for hydrosalpinx and pyosalpinx, a comprehensive examination is conducted to identify possible contraindications to laparoscopy, which includes: assessment of overall health, laboratory and instrumental research methods such as ultrasound, hysterosalpingography, or MRI to visualize the state of the fallopian tubes, and infection tests.

During the preoperative consultation with the surgeon and anesthesiologist, all aspects of the intervention, anesthesia, expected results, and recovery period are discussed.

How the Laparoscopic Surgery for Hydro- and Pyosalpinx is Conducted

Laparoscopic intervention is a minimally invasive method and consists of the following stages:

1. Anesthesia: General anesthesia is typically applied.
2. Trocars Insertion: Through small incisions (usually 5-10 mm) in the abdominal cavity, surgical instruments will be introduced.
3. Insufflation: The abdominal cavity is inflated with carbon dioxide to make the surgical area more visible and convenient for manipulation.
4. Laparoscope Insertion: A special device equipped with a camera is introduced for visualization of the pelvic organs.
5. Surgical Correction:
   • In the case of hydrosalpinx, salpingectomy is performed—removal of the affected tube or salpingostomy (creating a new opening in the tube).
   • In pyosalpinx, abscess drainage is performed, and the infected tube is usually removed to prevent recurrence.
6. Closing the Incisions: Instruments are removed, and incisions are sutured.

Rehabilitation Period

Recovery after laparoscopic surgery typically occurs faster than after open surgery, and the risk of complications is lower. 

In the first hours after the operation, patients are monitored by medical staff in the hospital, after which they may be discharged that same day or the next. Antibiotics and pain relief medications are taken as prescribed by the physician. 

Light physical activity can be resumed after a few days, while more strenuous activities should be postponed until full recovery. A follow-up visit is also scheduled to assess the condition, recovery progress, and prevent complications.

Although laparoscopic methods of surgery are safer than open operations, possible complications may include infection, formation of intra-abdominal adhesions, and damage to adjacent organs.

Laparoscopic surgery for hydrosalpinx and pyosalpinx is an effective treatment method with minimal risk of complications that allows addressing infertility related to tubal factors.