Chapter 77: PEARS for the Fallopian Tubes: Proximal Tubal Occlusion with Tubal Reimplantation

Hilgers TW

Reproductive Surgery Tubal Surgery

Chapter 77: PEARS for the Fallopian Tubes: Proximal Tubal Occlusion with Tubal Reimplantation

Hilgers TW

The Medical and Surgical Practice of NaProTECHNOLOGY, 1045-1056, 2004

RRM Academy Synopsis

PEARS reimplants a blocked fallopian tube over a stent

PEARS removes the blocked end of a fallopian tube and reimplants the tube. The textbook chapter shows the surgery in photographs of one 36-year-old woman. Her blockage came from salpingitis isthmica nodosa, a swelling condition of the tube near the uterus. A stitch left in the tube holds it open while it heals.

Key Findings

The chapter names the causes of proximal tubal occlusion: endometriosis in the tube's first stretch, salpingitis isthmica nodosa, congenital luminal stenosis, and fibrosis after infection or other causes.
A circular skin punch biopsy cuts through the cornual portion of the tube and removes the diseased section, leaving a clean cylindrical channel for the reimplanted tube.
A suture runs through the tube, into the uterine cavity, and out through the abdominal wall as a stent. The stent comes out in the office at the two-week visit.
The usual hospital stay after the operation is three days.
The author states that several patients went to full term and delivered vaginally. The chapter gives no count.

RRM Context

Reconstructive tubal surgery targets the blockage itself. IVF bypasses the tubes and leaves any blockage in place. The chapter belongs to NaProTechnology, formalized by Dr. Thomas W. Hilgers. In the case, laparoscopy found the blockage and selective hysterosalpingography confirmed it. The operation includes an inversion technique for adhesion prevention.

Our editorial summary of this paper, not the article's abstract.

Abstract

This chapter describes the PEARS technique for proximal tubal occlusion, which the chapter attributes to causes including endometriosis of the proximal tube, salpingitis isthmica nodosa (SIN), congenital luminal stenosis and fibrosis. A 4-mm circular skin punch biopsy cuts a cylindrical channel through the cornual portion of the uterus, the diseased tube is excised until a patent lumen is found, and the tube is reimplanted into the channel and secured with interrupted 6-0 Prolene sutures. A 2-0 Prolene suture threaded through the tube, the uterine cavity, the fundus and the lower abdominal wall serves as a stent and is removed at a postoperative visit about two weeks after surgery. The chapter states that several patients have carried full-term infants after the procedure and that the author sees no need for cesarean section.

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Topics

Reproductive Surgery › Tubal Surgery › Tubal Anastomosis · Infertility › Tubal Factor › Proximal Tubal Obstruction · Restorative Reproductive Medicine › NaProTechnology › Protocols and Framework

Thomas W Hilgers

Tom Hilgers, T Hilgers

Hilgers et al. 2004, Hilgers 2004

Chapter 77: PEARS for the Fallopian Tubes: Proximal Tubal Occlusion with Tubal Reimplantation

PEARS reimplants a blocked fallopian tube over a stent

Key Findings

RRM Context

Abstract

Read the guides

Topics

By this author

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