Fimbrioplasty

Definition - What does Fimbrioplasty mean?

Fimbrioplasty is a surgical procedure which involves reconstructing small, finger-like projections situated close to the ovaries at one end of the Fallopian tubes, called fimbriae. Fimbriae are covered with tiny hair-like projections termed as cilia that propel the egg released from the ovary into the Fallopian tube and towards the uterus. Fimbioplasty is a fertility procedure that is performed in women with infertility secondary to some abnormality of the fallopian tubes, known as tubal factor infertility. The procedure is done as a last resort in the evaluation of infertility until other options have been pursued. By preserving the fallopian tubes, fimbrioplasty provides some potential for a spontaneous pregnancy.

FertilitySmarts explains Fimbrioplasty

The ideal candidate for fimbrioplasty is a young woman with patent (open) fallopian tubes except for the fimbrial end. The woman undergoing fimbrioplasty may have one of the following tubal abnormalities:

  • Hydrosalpinx: Fallopian tube is filled with fluid
  • Pelvic inflammatory disease with blockage of the fimbrial end of the tube secondary to adhesions or scars (excessive scar formation and damage to the fallopian tube abandons fimbrioplasty)
  • Endometriosis with damage to the fimbrial end of the tube

The fimbrioplasty aims to open the blocked fallopian tube and preserve as many fimbriae as possible to allow successful capture and transit of the egg shed from the ovary.

Prior to the procedure, a long plastic tube called catheter is inserted into the bladder to prevent bladder expansion, thereby minimizing the risk of puncture of the bladder and enabling visualization of pelvic structures. The surgeon first performs a laparoscopy to determine the status of the fallopian tubes. The woman is placed on the operating table on the back, ideally with the feet above the level of the hips and the buttocks positioned a few inches beyond the edge of the operating table. If the fimbriae are blocked, they will look rounded (or clubbed). If the tube is patent, the surgeon performs the fimbrioplasty by dividing any visible adhesions. To identify the site of the blockage, a dye is injected through the fallopian tubes via a catheter placed in the uterus – a procedure called transcervical chromopertubation. The tube is opened with forceps and fimbrial edges are released. With the fimbriae being completely liberated, an opening is finally created at the fimbrial end of the tube to facilitate patency of the tube.

Massive bleeding is prevented by adequately separating the fold of the ligament that envelops and supports the fallopian tube, referred to as mesosalpinx, from the ovary. In addition, the doctor uses irrigation, suction, and heat or cold application to control bleeding.

The site, type, and extent of tubal damage affect the chances of success of fimbrioplasty. The absence of or presence of small hydrosalpinges (< 15 mm in diameter), the absence of pelvic adhesions, and the presence of fimbriae during laparoscopy are all associated with a good outcome following tubal reconstructive surgery. Women with mild disease have a 5% probability of pregnancy per month. The outcome of fimbrioplasty for women with severe tubal damage is considerably worse, with a pregnancy rate of merely 1% to 2% per month. Women who fail to get pregnant after this reconstructive surgery are ideal candidates for assisted reproduction.

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