Salpingotomy

Salpingotomy is a fallopian tube preserving surgical procedure performed to remove a fertilised egg that has caused an ectopic pregnancy.

Female internal reproductive organs consist of ovaries, fallopian tubes, uterus, and vagina. The uterus, also called the womb, is a pear-shaped organ that houses the developing fertilised egg. The ovary is an oval-shaped egg-producing gland, one on each side of the uterus. Each ovary connects to the uterus through a narrow tube called the fallopian tube, which carries the egg produced by the ovaries into the uterus. The sperms that enter the female reproductive system fertilise the egg in the fallopian tube, which is subsequently transported to the uterus for development. However, in case of ectopic pregnancy, the fertilised egg is implanted outside the uterus, many times in the fallopian tube, where it cannot develop into a baby. If the ectopic pregnancy remains untreated, it can also put the health of the woman at risk. Some factors that increase the risk of this condition include smoking, increasing age (35 to 40 years old), and pelvic inflammatory disease.

Ectopic pregnancy can be removed by two types of surgeries, salpingectomy and salpingotomy. Salpingectomy involves the complete removal of the affected fallopian tube, while salpingotomy involves removal of the ectopic pregnancy without removing the fallopian tube. Salpingotomy consists of making a cut on the fallopian tube to remove the fertilised egg and preserving the fallopian tube for future pregnancies.

Salpingotomy is recommended for the management of an ectopic pregnancy that occurs in the fallopian tube. 

The procedure is especially done in case of a large ectopic pregnancy, high hormone human chorionic gonadotropic (hCG) levels and significant internal bleeding. Symptoms of an ectopic pregnancy usually start showing after the fourth week of pregnancy and include:

• Brown-coloured watery discharge or bleeding from the vagina
• Pain on one side of the lower abdomen
• Discomfort while urinating or emptying the bowels
• Pain in the lower back
• Signs of pregnancy such as a missed period
• Dizziness

The relative contraindications (surgery can be performed but with caution) associated with salpingotomy include rupture of or acute bleeding in the fallopian tube.

Prior to the surgery, the surgeon will conduct a preoperative examination that includes blood tests (to measure hCG levels), urine tests, and an ultrasound. You will need the following preparation before the surgery:

• Avoid eating or drinking anything six hours prior to the surgery. However, you will be allowed to drink water.
• Before arriving at the hospital on the scheduled day of the surgery, take a shower and remove any body piercings, jewellery, and nail polish you may have on.
• Make an arrangement for someone to drive you home after the surgery.
• You will need to sign an approval or consent form to grant your permission for the procedure.

Read more: Beta HCG test

After you arrive at the hospital, the hospital staff will ask you to wear a hospital gown. They will then start an intravenous (IV) line in your arm or hand to give you essential medicines and fluids during the operation. The surgery can be performed by an open or laparoscopic method. 

In the operation theatre, you will be given general anaesthesia (a medicine that puts you into a deep sleep) and the following steps will be performed for the laparoscopic procedure:

• The surgeon will make a small incision (cut) at your navel and two other small cuts on the lower part of your abdomen.
• He/she will inflate your abdomen with carbon dioxide gas to allow more space while operating.
• Next, the surgeon will insert a tube-like instrument containing a camera into your abdomen through the cut on your belly button. He/she will insert other surgical instruments into your abdominal cavity through the other cuts on the lower belly.
• Thereafter, the surgeon will make a cut in your fallopian tube to remove the ectopic pregnancy tissue.
• Finally, he/she will close the wound closed using dissolvable stitches.

In open surgery, one large cut is made on the lower abdomen instead of many small ones.

The surgery usually lasts for more than 30 minutes. After the procedure, you will be placed in the recovery ward and then to a hospital room after keeping you under observation for a short period (up to two hours). You will be discharged from the hospital in one to two days.

Once you reach home, you will need to take the following care:

• In the initial days following the surgery, you should try moving around and walking small distances. Increase the distance slowly over the next few days. However, avoid standing for extended periods.
• You may have bleeding from the vagina, similar to your period, during the initial one to two weeks following the surgery. Some women experience spotting and bleeding until six weeks following a salpigotomy.
• You may have abdominal pain or discomfort during the recovery period, it is due to the gas filled in your the abdomen for the procedure. The discomfort can be relieved by moving around, applying a heat pack, and drinking peppermint tea.
• Your surgeon will advise you to shower after 48 hours following the surgery. Make sure to keep the wound clean.
• Keep the operated site open (uncovered). However, if the stitches are irritated due to rubbing or pulling against your clothes, you can cover the wound with a less adherent dressing.
• Avoid indulging in rigorous activities and heavy lifting for at least two weeks after the surgery.
• Your surgeon will recommend that you take two to six weeks away from work after the surgery to cope with your emotions and to allow your body to heal.
• You will get your period four to six weeks after surgery, and your periods will become regular in two to three months.
• Your body may require about three months to recover from the surgery. You will be advised to plan for another baby only after this period.

When to see the doctor?

You should inform your doctor immediately if you experience any of the following symptoms:

• Fever
• Chills
• Redness near the wound
• Soreness at the operated site
• Pain near the operated area
• Fluid drainage with bad smell from the incision

The possible complications associated with the surgery include:

• Damage to the abdominal organs like intestines and bladder
• Infection in the wound, urinary bladder, or pelvis
• Bleeding from the operated site
• Need for a resurgery
• Injury to the lower part of the uterus (cervix)
• Complications of anaesthesia like vomiting, nausea, and allergic reaction to anaesthesia

Sometimes some tissue from the ectopic pregnancy remains in the fallopian tube. In such a case, another surgery or medical treatment will be required.

Your surgeon will ask you to visit the hospital one week after the surgery to check your blood hCG levels. A drop in the level of hCG helps determine the complete removal of ectopic pregnancy. You may also be given an appointment with a specialist nurse to help you deal with the loss of pregnancy.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.