Neosalpingostomy / Fimbrioplasty

Neosalpingostomy is surgery that creates a new opening at the blocked far end of a fallopian tube. Surgeons most often reach the fimbriated end, the far end of the tube, through a laparoscope and small incisions. Some perform it as open microsurgery. A blocked, fluid-filled tube (hydrosalpinx) is the most common reason for this surgery. A related surgery, fimbrioplasty, repairs a tube end that is only partly blocked or stuck together. Surgeons use it when some healthy tissue remains. Both surgeries treat damage at the far end of the tube. This problem differs from a blockage near the uterus. Past pelvic infection, pelvic inflammatory disease, and scar tissue from endometriosis are the most common causes of this damage.

Results after neosalpingostomy depend on the severity of tubal damage at the time of surgery. One hospital reviewed 402 laparoscopic fimbrioplasty and neosalpingostomy cases. It had follow-up data on 260 of those women. Among the 260, there were 74 pregnancies (28.48%). Of those, 68 (26.1% of the 260 women) were pregnancies in the uterus. The other 6 (2.3%) were ectopic, meaning the pregnancy grew outside the uterus.¹ The stage of tubal disease had a strong effect. Stage 1 (mild) disease had a 63% pregnancy rate. Stage 3 had 15%. Stage 4 had 0%. With no scar tissue around the tube and ovary, the pregnancy rate was 73.91%. With severe scar tissue, it fell to 8.8%.¹ These figures make patient selection the key step. For mild to moderate damage, neosalpingostomy is a viable restorative option. For severe damage, the odds change.

The restorative principle here is to preserve the tube rather than remove it. Removing a hydrosalpinx and proceeding directly to IVF bypasses the tube. It does not repair anything. Neosalpingostomy seeks the opposite result: a working tube, so the couple can conceive naturally. Several factors determine whether a tube is worth repairing. They include the amount of healthy tissue at the tube end and the amount and density of scar tissue. They also include the thickness of the tube wall and the overall condition of the pelvis. Surgeons assess these factors during the surgery. Imaging alone cannot always predict them.

The risk of ectopic pregnancy increases after neosalpingostomy. The risk rises with the extent of tubal damage. In the same series, 6 of the 260 women with follow-up (2.3%) had an ectopic pregnancy.¹ Early pregnancy monitoring with blood tests (beta-hCG) and ultrasound is standard after any tubal surgery. The tube can also close again over time, or a hydrosalpinx can form again. This outcome is more likely in moderate to severe cases.