58672 Laparoscopy, surgical; with fimbrioplasty

Name of the Procedure:

Laparoscopy, surgical; with fimbrioplasty

Summary

Laparoscopy with fimbrioplasty is a minimally invasive surgical procedure that repairs and reconstructs the fimbriae, which are delicate, finger-like structures at the end of the fallopian tubes. This procedure is typically performed through small incisions using a camera and specialized instruments.

Purpose

This procedure addresses issues related to blocked or damaged fimbriae, which can interfere with fertility by preventing the egg from traveling from the ovary to the uterus. The goal is to restore the normal function of the fimbriae, thereby improving the chances of natural conception.

Indications

• Women experiencing infertility due to tubal factors
• Blockage or damage to the fallopian tubes identified during diagnostic tests (e.g., Hysterosalpingography or HSG)
• History of pelvic inflammatory disease (PID)
• Endometriosis affecting the fallopian tubes

Preparation

• Fasting for at least 8 hours before the procedure
• Adjustments or cessation of certain medications as advised by the doctor
• Diagnostic tests such as ultrasound, HSG, or blood tests to assess overall health and reproductive anatomy

Procedure Description

1. The patient is administered general anesthesia.
2. Small incisions are made in the abdominal wall.
3. A laparoscope (camera) is inserted through one incision to provide visuals.
4. Specialized surgical instruments are inserted through other incisions.
5. The surgeon examines the fallopian tubes and performs the fimbrioplasty, which may involve removing blockages and repairing fimbrial damage.
6. The instruments are removed, and incisions are closed with sutures.

The procedure typically uses carbon dioxide gas to inflate the abdomen for better visualization.

Duration

Approximately 1 to 2 hours.

Setting

Usually performed in a hospital or outpatient surgical center.

Personnel

• Surgeon (typically a gynecologist or reproductive surgeon)
• Surgical nurses
• Anesthesiologist

Risks and Complications

• Infection at the incision sites
• Bleeding or hematoma formation
• Injury to nearby organs such as the bowel or bladder
• Adverse reactions to anesthesia
• Scar tissue formation (adhesions)
• Persistent pain or discomfort

Benefits

• Improved fertility and higher chances of natural conception
• Minimal scarring due to small incisions
• Shorter recovery time compared to open surgery

Benefits can often be realized within a few months post-procedure, as natural conception may occur during subsequent ovulatory cycles.

Recovery

• Initial recovery period of 2-7 days with limitations on physical activities
• Pain management with prescribed medications
• Instructions on wound care and signs of infection to watch for
• Follow-up appointments to assess healing and success of the procedure

Alternatives

• In Vitro Fertilization (IVF): An alternative for women who do not wish to undergo surgical repair or have non-reparable tubal damage
• Other tubal surgeries such as salpingostomy or tubal anastomosis, depending on the specific condition of the tubes
• Pros and cons should be discussed with the healthcare provider to determine the most appropriate treatment.

Patient Experience

During the procedure, the patient is under general anesthesia and will not feel pain. Post-procedure, patients may experience mild to moderate abdominal discomfort, bloating from the gas used to inflate the abdomen, and minor pain at the incision sites. Pain is typically managed with medication, and most patients resume normal activities within a week, following their surgeon's advice for a safe recovery.