Fimbrioplasty is a reconstructive procedure used to correct problems in the fallopian tube. Fimbrioplasty has the advantage that it takes care to preserve and release the delicate fimbariae, which is very important in making pregnancy possible. This surgery is usually conducted only after making a comprehensive study about the infertility problem faced by the couple under investigation
Before conducting fimbrioplasty, the surgeon usually conducts a diagnostic laparoscopy. During this test the pelvis of the patient is thoroughly examined. If the fallopian tubes are seen severely damaged on both sides, it is better to abandon this procedure. A patient whose fallopian tube is healthy except for the presence of clubbed fimbariae is suitable for fimbrioplasty. The clubbed end of the fallopian tube is slightly enlarged by injecting a solution of indigo carmine through uterus. After completing the procedure the laparoscope is withdrawn and the incision is closed by suturing.
How fimbrioplasty is performed?
Pfannenstiel incision is made in the abdomen for carrying out this surgical procedure. A good light source and a good lens for magnifying the visuals are essential components needed for the successful completion of this procedure. The adhesions are removed using micro tip cautery. Before opening the clubbed end of the tube, small vessels are coagulated using a micro tip electrical cautery. The scars over the tube’s clubbed end are separated. Scared serosa is stitched back to the serosa of the tube so that the fimbriae are free and keep the fallopian tube open. To check whether the passage of the fallopian tubes are open the lower portion of the uterus is pinched between the first finger and the thump and indigo carmine is injected through a needle inserted through the fundus. If there is no obstruction, this indigo carmine will spill through the tubes. After completing the procedure the instruments are withdrawn and the incision is sutured. A patient who has undergone this procedure has to be subjected to hydrotubation on alternate days for a period of two weeks. In this process a solution containing antibiotics, cortisone and saline are injected through a rubin cannula inserted to the cervix through vagina.
Important points to be remembered
Meticulous care has to be shown in achieving hemostasis as it is very essential for this surgical procedure to become successful. Hemostasis has to be controlled by proper suction, irrigation and needle point electrocautery rather than by sponging, clamping or tying of blood vessels. Vascularity of the fallopian tube has to be maintained. For achieving this excessive dissection of mesosalpinx from ovary has to be avoided.