Uma mogs2015result

AUTHOR-DR A.R. ANAND [PROF & HOU]
PRESENTOR– DR UMA TRIPATHI (JUNIOR
RESIDENT)

 Tuboplasty is surgical approximation of
tubal segment after tubal sterilisation or
excision of an occluded or diseased portion
of fallopian tube.
 Tuboplasty through minilaprotomy incision is
a new discipline that synergizes the potential
of classical microsurgery and laparoscopy.

 To study the success of tubal recanalisation
procedure through minilaprotomy

 Reversal of tubal sterilization procedure in
case of untimely death of child or children
 Remarriage

 All the pt which were requesting for tubal
recanalisation for above mentioned reason
for tubal ligation
 Pt with husband semen analysis with in
normal limit
 Other obvious causes of female infertility
ruled out.

 Male infertility
 Female requesting for tubal renanalisation
after having live baby of either sex & staying
with them
 Other chronic debilitating illness
 Pt with previous 2 cesarian section

 All the pt fullfilling the above mentioned
criteria
 Duration of study : 2010 to 2014
 Study area :JJ hospital , Mumbai
 Pt were posted for surgery after all
preoperative workup.
 Postoperatively pt were followed up with
HSG report after 3 month

 Tuboplasty is done through minilaprotomy
incision along with micro-technique using
fine instruments with fine suture material
[vicryl 6-0] .

 Written informed consent taken
 Patient was placed in lithotomy position
 Cervical catheterisation done with foley’s
catheter no 8
 Pt taken in supine position
 Parts painted and draped
 Small transverse incision [2-2.5 cm ]taken
over suprapubic area

 Abdomen opened in layers
 One side of fallopian tube traced with the
help of babcock’s forcep and delivered
outside abdomen
 Two ends of previous tubal ligation site
identified ,edges freshened up ,patency of
tubes checked after methylene blue dye was
injected through cervical catheter .

 First mesosalphinx is approximated at 6 o clock
position on both the sides i.e. anterior &
posterior.
 First suture was taken with 6-0 polyglactin
(vicryl) in the muscles.
 Second suture was taken at 3 & 9 o’clock with
the same material.
 Third suture was taken at 12 o’clock.
 Serosa was sutured in continuous manner .
 Tubal patency checked by injecting methylene
blue dye through cervical catheter and spillage
checked at fimbrial end.
 And patency confirmed .

 Then fallopian tube reposited in abdomen
 Same procedure repeated on opposite side
 Opposite Tubal patency checked by injecting
methylene blue dye through cervical
catheter and spill checked at fimbrial end .

 Microsurgical principles are well maintained
like magnification, tissue handling,
haemostasis & lavage
 Less tissue handling & trauma
 Adhesions are less
 Less postoperative pain
 Faster recovery
 Early ambulation
 Cosmetically better scar

 In our study, 38 patient underwent
tuboplasty through minilaparotomy access on
day 5 hydrotubation 30 cases [79% ] had
bilateral spillage and 8 cases [21% ] had
spillage in unilateral tube .
 Pt is asked to follow up in opd after 3 months
with HSG report.
 Out of 38 patient, 36 cases came for follow
up with HSG report which showed bilateral
tubal patency in 28 cases [78%] and 8 cases
[22%] had unilateral tubal patency.

 Earlier Tuboplasty was done through
conventional laparotomy access, which was
associated with more tissue injury, foreign body
contamination of peritoneal cavity, higher post-
operative pain, adhesions and slower
rehabilitation.
 Latter with advancement of laparoscopy,
Laparoscopic Tuboplasty started, although it is
associated with minimal tissue injury, less
adhesions and faster recovery but it requires
longer operative time, risk of visceral injury and
need for general anesthesia with expertise in
laparoscopic technique.

 Tuboplasty done through Minilaparotomy
incision offers combined advantage of both
conventional and laparoscopic recanalization
 This technique offer precise tissue
alignment, which can be confirmed with
direct tactile feedback.
 Easier operative technique due to no
requirement of in depth surgery.
 Less adhesions, post operative pain and
equivalent recovery period as compared with
laparoscopic technique.

 Surgical scar even smaller than laparoscopic
technique (i.e. combined multiple port site
scar)

 Definitely Minilap Tuboplasty have
advantages of
 Safer in high risk patients
 Can be done in regions where laparoscopic
facility is not available
 Smaller learning curve
 3-Dimensional surgery with tactile feedback
Along with carrying advantage of laparoscopic
surgery i.e. earlier recovery and better cosmetic
scar.

Uma mogs2015result

More Related Content

What's hot (20)

Similar to Uma mogs2015result (16)

Uma mogs2015result