Salpingostomy is a surgical procedure involving an incision into a Fallopian tube (Pic. 1). This may be done either to create a new opening of the Fallopian tube and restore its patency, or to remove an ectopic pregnancy (Pic. 2). Salpingostomy is considered a conservative approach in contrast to salpingectomy, in which the damaged tube, or the tube affected with ectopic pregnancy is removed, leaving only one Fallopian tube for reproductive capacity. Salpingostomy, on the other hand, preserves both tubes, albeit at the cost of higher risk of recurrence of ectopic pregnancy.
Salpingostomy is one of the surgical procedures used to treat ectopic pregnancy (EP). Ectopic pregnancy occurs when a fertilized egg implants anywhere outside the uterus, most commonly in the Fallopian tube wall. The growing embryo inside the Fallopian tube may erode its wall and cause it to rupture. Ruptured ectopic pregnancy (Pic. 3) is a medical emergency as it causes severe bleeding into the abdominal cavity. Therefore, ectopic pregnancy should be diagnosed as early as possible. The drug methotrexate may be used to manage the condition non-invasively, as it inhibits the growth of the embryonic cells. If the medical treatment has failed or is not possible, the ectopic pregnancy has to be removed surgically. To remove the products of conception in the case of an ectopic pregnancy, so-called linear salpingostomy is performed, with a single incision made through the tubal wall at the site of the ectopic pregnancy, allowing for the products of the conception to be removed.
Salpingostomy may be also used to treat patients with damaged Fallopian tubes, such as by adhesions (bands of fibrous scar tissue) that obstruct the tube’s lumen, and patients with hydrosalpinx (Pic. 4) – an accumulation of clear fluid in the lumen of the tube, which distends it significantly and gives it a sausage-like shape. In patients with hydrosalpinx, salpingostomy may be used to create a new opening of the Fallopian tube into the abdominal cavity, and therefore to restore its patency. In such cases, the procedure is called neosalpingostomy.
Salpingostomy is usually performed under general anesthesia. It may be performed via laparotomy, an incision in the abdominal wall which allows the Fallopian tubes to be visualised and operated on. Salpingostomy may be also performed laparoscopically, with several small incisions made in the abdominal wall, through which the instruments, a light source and a video camera are inserted, allowing for a mini-invasive approach to the Fallopian tubes.
The major advantage of salpingostomy over salpingectomy in surgical management of ectopic pregnancy is that it spares the affected Fallopian tube, and in the majority of cases, manages to restore its patency. Some authors report an increased pregnancy rate and a shorter time to an uterine pregnancy in patients treated with salpingostomy compared to patients treated with salpingectomy. Salpingostomy is therefore also recommended as the method of choice in patients with a pathology of the both Fallopian tubes. In these patients, salpingostomy is associated with better pregnancy rates, although at the cost of increased risk of repeated ectopic pregnancy.
Salpingostomy is also indicated for the treatment of ectopic pregnancies located in the ampulla of the Fallopian tube, whereas EPs located in the isthmus of the tube are treated by excision of the affected segment and anastomosis (attaching the loose ends of the tube together).
Salpingectomy, on the other hand, is used when the ectopic pregnancy has ruptured, or the tube is seriously damaged. Salpingectomy is also recommended in patients who have experienced recurrent ectopic pregnancies.
Complications associated with salpingostomy include infection, excessive bleeding and formation of adhesions. In patients with ectopic pregnancy, the procedure carries the risk that not all the products of conception will be removed and the ectopic pregnancy will persist. The persistent pieces of tissue may then continue growing, and further treatment is necessary. Persistent ectopic pregnancy occurs in approx. 5 – 10% of cases.
Salpingostomy is successful in 93% of cases, and 76% of patients have patent tubes after the procedure. The chance of future pregnancy depends on the status of the adnexa left behind. The chance of recurrent ectopic pregnancy is about 10% and depends on whether the affected tube was repaired (salpingostomy) or removed (salpingectomy). Successful pregnancy rates vary widely, and depend, among other factors, on the skill and experience of the operator. Sometimes, patients may have to resort to in vitro fertilization to achieve a successful pregnancy. The use of in vitro fertilization (IVF) does not preclude further ectopic pregnancies, but the likelihood is reduced.