SALPINGECTOMY

SALPINGOSTOMY
dr. Muthiah Nurul Izzah
Definition

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Indications
Ectopic pregnancy removal
Sterilization
Hydrosalpinx removal
Ovarian cancer prevention

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Laparotomy VS Laparoscopy
Laparotomy Laparoscopy
Suitable for patient with unstable Shorter operation time and
hemodynamics hospitalization
Contraindication to laparoscopy Lower blood lose
Fast entry into the abdomen for control Quicker recoveries
of bleeding in hempoperitoneum Less operative pain

Tubal patency, subsequent intrauterine pregnancy, and repeat ectopic pregnancy

rates were similar for the two types of entry

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Salpingostomy VS Salpingectomy
Salpingostomy
Desire to conserve fertility
Hemodinamically stable
Tubal pregnancy is accessible
Unruptured and <5cm insize
Absent or damage contralateral tube
Salpingectomy
Severe bleeding or hemodynamically
unstable patient
Recurrent ectopic pregnancy in the same
tube
Severely damaged tube
Completed childbearing

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PREOPERATIVE
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INFORMED CONSENT

-Complications mostly related to ectopic pregnancy and risk of bleeding

-Injury to the ipsilateral ovary
-Persistent Trophoblastic tissue (higher risk with salpingostomy, prophylactic
systemic MTX should be administered within 24 hours of surgery and serum
hCG levels monitored until undetectable)

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Preservation of Fertility
with a healthy contralateral tube, neither salpingostomy nor salpingectomy overs a distinct
fertility advantage
salpingostomy is considered a preferred option for tubal ectopic pregnancy if there is
contralateral tubal damage and a desire or fertility
in some cases of rupture, the extent of tubal damage or bleeding may limit tubal salvage, and
salpingectomy may be required.

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Patient Preparations
Hematology testing (Complete Blood Count, B-hCG)
Crossmatch
Prophylaxis antibiotics

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INTRAOPERATIVE

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 General or regional anesthesia
Surgical
Steps Position supine

Anesthesia
& patient Clipped hair in planned incision area

positioning
Foley catheter placement

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 Most salpingectomy or
Surgical salpingostomy procedures can be
managed trough Pfannenstiel
Steps incision
Laparotomy
Abdominal Hemodynamically unstable patient
Entry  Vertical incision for quicker entry

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SALPINGECTOMY
1. Once access to the pelvic organ has been
achieved, the adnexa is elevated.
2. Distal and proximal Babcock clamps are placed
around the fallopian tube and direct the tube
away rom the uterus and ovary. This extends the
mesosalpinx
3. Beginning at the distal, fimmbriated end of the
tube, one Kelly clamp or hemostat is placed
across a 2-cm-long segment o the mesosalpinx,
close to the allopian tube. The clamp’s curve
aces the tube. Another clamp is similarly placed,
but lies closer to the ovary. These clamps
occlude vessels that traverse the mesosalpinx.
Scissors then cut the interposed mesosalpinx.

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SALPINGECTOMY
4. The severed tissue pedicle that is closer to the
ovary is tied with 2-0 or 3-0 gauge delayed-
absorbable suture, and the clamp is removed.
The clamp closer to the tube remains and leaves
with the nal specimen. Such clamping, cutting,
and ligating are repeated serially, with each
clamp incorporating approximately 2 cm of
mesosalpinx.
5. Progression is directed from the ampullary
end o the fallopian tube toward the uterus.
6. The last clamp is placed across the proximal
mesosalpinx and fallopian tube. Scissors then
cut the mesosalpinx and tube and reef these
from the uterus. This pedicle is similarly ligated

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LAPAROSCOPIC SALPINGECTOMY
Techniques of laparoscopic salpingectomy
using bipolar cautery and excision.
A: Serially desiccate and cut across the
mesosalpinx toward the tubal isthmus using an
electrosurgical device, taking care to avoid
compromising the blood supply to the ovary.
B: Cross the tube at its proximal edge,
desiccate, and excise the tube.

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SALPINGOSTOMY
1. the affected fallopian tube is elevated with Babcock
clamps.
2. At the ectopic pregnancy site, the tube is sharply incised
lengthwise on its antimesenteric border. The incision,
usually 1 to 2 cm long, varies based on pregnancy size.
3. The products o conception are grasped and gently
extracted or are delivered by hydrodissection.
4. Bleeding sites are made hemostatic with electrosurgical
coagulation, and the tubal incision is left to heal by
secondary intention.

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LAPAROSCOPIC SALPINGOSTOMY
Grasp the distal end of the tube with blunt forceps.
Inject dilute vasopressin into the mesosalpinx. Make a
linear incision on the antimesenteric side of the
distended tube at the presumed ectopic pregnancy site.
Express the products of conception bluntly using
pressure, forceps, suction, or hydrodissection. Irrigate
the lumen with lactated Ringer solution to ensure
complete removal of trophoblastic remnants.
If products of conception are not clearly seen, collect
clot for evaluation.
If laparoscopy, place the specimen in an endoscopic bag
and remove.
Obtain hemostasis with bipolar coagulation.
Allow the tube to heal by secondary intention.

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Laparoscopic Salpingostomy
(neosalpingostomy and fimbrioplasty)
A: The occluded distal end of the tube usually has
a centrally placed avascular area, from which
avascular scarred lines extend in a cartwheel
manner.
B: The first incision is made along an avascular line
toward the ovary.
C: Avascular lines are incised by viewing from
within the tube along the circumference of the
initial opening.
D: Cutting along the avascular lines is continued
until a satisfactory stoma is fashioned.
E: The flaps can be everted by placing two or three
no. 6-0 absorbable synthetic sutures.

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 The pelvis is irrigated and rid of blood and
tissue debris.
Surgical The abdominal incision is closed
Steps
Wound
Closure

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POST-OPERATIVE

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 Post operative
Recovery of Abdominal Bowel Function Postoperative activity
Incision
Midline incision lead to significant Return of normal bowel function was Vigorous abdominal exercise is
pain during ambulation slowed  Monitoring signs of ileus delayed for 6 weeks to allow for
fascial healing
Early mobilization to prevent
thrombotic and pulmonary
complications

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Thank YOU

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