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LAPAROSCOPIC TUBAL RECANALISATION

WHAT DO YOU MEAN BY TUBAL RECANALISATION

Fallopian tube recanalisation by guidewire is a treatment for infertility caused by blocked fallopian tubes, especially if the blockage is close to the entrance to the uterus (proximal). It is carried out during the same treatment session as diagnostic salpingography and involves inserting a fine tube (catheter) past the obstruction in a fallopian tube. This, or the subsequent injection of radio-opaque dye, may clear the obstruction. If these strategies fail, a guidewire may be passed up into the fallopian tubes through the catheter, and manipulated to clear the obstruction.

Fallopian tube recanalization (FTR) is a nonsurgical procedure our interventional radiologists use to treat these blockages. Recanalization is the medical term for “reopening.”During the procedure, which does not require any needles or incisions, we will place a speculum into the vagina and pass a small plastic tube (catheter) through the cervix into the uterus. Inject a liquid contrast agent (sometimes called a dye, although nothing is stained) through the catheter. Examine the uterine cavity on a nearby monitor using an X-ray camera. Obtain a hystero-salpingogram or HSG. Literally, that means a “uterus-and-fallopian-tube-picture.Determine if there is a blockage and if it is located on one or both fallopian tubes.Thread a smaller catheter through the first catheter and then into the fallopian tube to clear the blockage. More than 90 percent of the time, we can reopen at least one blocked fallopian tube and restore normal function.

HOW TO PERFORM TUBAL RECANALISATION?

The procedure is done under sterile conditions to avoid the possibility of introducing infection. The overall time to do the procedure is about a half an hour, most of which is spent in getting you comfortable, readying the equipment, and cleaning the skin. The actual time spent in evaluating and unblocking the tubes is usually only a matter of minutes and you will be able to leave about a half hour after your procedure is completed. You must be accompanied by an adult who can take you home afterward. The doctors will explain to you and your companion the results and a letter will be sent to your doctor as well. Preparation for the procedure Two days before your procedure, your gynecologist will prescribe an antibiotic called Doxycycline to be taken twice a day, which you will continue up to and after your procedure for two more days. Since this is sometimes uncomfortable (though usually much less than a hysterosalpingogram, owing to much more delicate equipment being used), an intravenous line is placed prior to the procedure. Short-acting medications will be given for relaxation and pain relief. For this reason, you will be instructed to not eat anything after midnight the night before. You will also be asked to take Ibuprofen 400 mg (2 pills) the night before and the morning of your procedure.

OUTCOMES OF TUBAL RECANALISATION?

Usually, both fallopian tubes can be unblocked. On average, about a quarter of couples will conceive, most within a cycle or two. This procedure was timed so that there was no risk of being fertile at the time of your procedure. You may begin trying to get pregnant again once the spotting has stopped, and don’t have to wait an extra cycle in between. Douching is not advisable in general, but particularly after this because the cervix may be slightly open for a day or so. Successful after this procedure and pregnancy are lower when severe scarring is present from prior surgery or bad infections, such as Pelvic Inflammatory Disease. This procedure unclogs the tubes, but does not reverse the process at work that caused them to become blocked in the first place. For that reason, about 1/3 of patients will reocclude their tubes by about 6 months. You may wish to consult your doctor if you have not gotten pregnant after 6 months and he or she is thinking about enhancing your fertility, such as giving you injections to stimulate your ovaries. It is advisable in that case to make sure that your tubes are still open. An interventional radiologist can perform this if blockage is again found.

SIDE EFFECTS OF TUBAL RECANALISATION

Most women will have a little spotting for a day or two afterward. We will give you a pad in recovery and you may wish to have some pads at home in case of spotting. There should be no lingering pain or other unpleasant sensation. If you experience pain, cramps, fever, or vaginal discharge, please contact your gynecologist immediately. If he or she is unavailable, contact Stanford Interventional Radiology and we will help with your problem.

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