Dissection of the closed tubal fimbria

Dissection of the closed tubal fimbria

When preliminary investigative studies of the tube with gas insufflation indicate a block somewhere in its course, the hysterosalpingogram will demonstrate the area of obstruction. In this instance the point of obstruction is obvious and occurs at the fimbriated end of the tube, with patency up to this point.

Guide for the surgeon with pictures – Dissection of the closed tubal fimbria

The chances of future pregnancy will improve materially if a simple plastic procedure is done on the closed ends.

Figure 4. Again a stay suture of the figure-of-eight type is placed in the fundus of the uterus and held on traction. The assistant draws the uterus toward the surgeon while the latter incises any peritubal adhesions and demonstrates the closure of the fimbriated ends of the tube.

Figure 5. With the uterus still held on traction the surgeon picks up the tube between thumb and forefinger to steady it as he incises the peritoneum and the adhesions covering the fimbriated end.

Figure 6. With the tube still held firmly in the fingers of the surgeon and the incision made, the undamaged tubal epithelium comes into view. The surgeon then gently inserts the blunt ends of a Kelly clamp into the lumen and exerts gentle lateral pressure by opening the blades of the clamp, thereby enlarging the ostia. A minor degree of trimming recreates the fimbria.

Figure 7. The operation is now complete. The tube is free of any peritubal adhesions which might interfere with its motility and the patency of the tube is restored by the plastic operation which opened the fimbriated end.

Dissection of the closed tubal fimbria

Dissection of the closed tubal fimbria

Dissection of the closed tubal fimbria

Dissection of the closed tubal fimbria

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