58673 Laparoscopy, surgical; with salpingostomy (salpingoneostomy)

Name of the Procedure:

Laparoscopy, surgical; with salpingostomy (salpingoneostomy)

Summary

Laparoscopy with salpingostomy is a minimally invasive surgical procedure where a small incision is made in the fallopian tubes to remove blockages or adhesions. This helps in improving fertility by allowing the egg to pass through the fallopian tube to the uterus.

Purpose

The main purpose of this procedure is to treat infertility problems caused by blocked or damaged fallopian tubes. By creating an opening in the fallopian tube, the procedure aims to restore normal passage for the egg, improving the chances of conception.

Indications

• Blocked or damaged fallopian tubes
• Hydrosalpinx (fluid in the fallopian tubes)
• Ectopic pregnancy
• Tubal adhesions
• Severe pelvic inflammatory disease (PID)
• Women experiencing infertility due to tubal factors

Preparation

• Fasting for at least 8 hours before the procedure.
• Stopping certain medications as advised by the surgeon.
• Undergoing routine blood tests, pelvic ultrasound, and other diagnostic imaging as required.

Procedure Description

1. The patient is placed under general anesthesia.
2. A small incision is made near the navel, and a laparoscope (a thin tube with a camera) is inserted to visualize the reproductive organs.
3. Carbon dioxide gas is used to inflate the abdomen for better visibility and access.
4. Additional small incisions may be made to insert surgical instruments.
5. The surgeon identifies the blocked or damaged section of the fallopian tube.
6. A salpingostomy is performed by creating an opening in the fallopian tube and removing blockages or adhesions.
7. The instruments and laparoscope are removed, and the incisions are closed with sutures or surgical staples.
8. The patient is awakened from anesthesia and moved to a recovery area.

Duration

The entire procedure typically takes about 1 to 2 hours.

Setting

The procedure is performed in a hospital or an outpatient surgical center.

Personnel

• Surgeon
• Surgical nurses
• Anesthesiologist
• Surgical technician

Risks and Complications

• Infection at the incision sites
• Bleeding
• Damage to surrounding organs (bowels, bladder)
• Adverse reaction to anesthesia
• Formation of scar tissue (adhesions)
• Ectopic pregnancy (a fertilized egg implants outside the uterus)
• Incomplete or failed procedure, requiring additional surgery

Benefits

• Improved chances of natural conception
• Minimally invasive, leading to shorter recovery time
• Reduced pain and scarring compared to open surgery
• Enhanced visualization of reproductive organs

Recovery

• Post-procedure, the patient may experience mild to moderate pain and discomfort.
• Pain management includes prescription or over-the-counter pain relievers.
• Patients can usually go home the same day but require someone to drive them.
• Avoiding strenuous activity and heavy lifting for at least 1-2 weeks.
• Follow-up appointment in 1-2 weeks to check healing and discuss further fertility plans.

Alternatives

• In-vitro fertilization (IVF)
• Tubal reanastomosis (reconnecting the fallopian tubes)
• Medical management of underlying conditions causing blockages (e.g., antibiotics for PID)
• Pros: IVF bypasses the need for functional fallopian tubes and has higher pregnancy rates.
• Cons: IVF is more expensive and invasive compared to laparoscopic salpingostomy.

Patient Experience

• During the procedure, the patient will be under general anesthesia and feel no pain.
• Postoperative discomfort is common but typically manageable with pain medication.
• Some patients may experience shoulder pain from the carbon dioxide gas used to inflate the abdomen.
• Normal activities can usually be resumed within a few days, although complete recovery may take a few weeks.