Fimbrial plastic with hood

Fimbrial plastic with hood

Inset A. Although a plastic reconstruction has been performed on the open end of the tube the surgeon may wish to ensure patency of the tube during the reparative phase by preventing adhesions from forming around the newly fashioned ostium. This can be accomplished by inserting a long polyethylene tube through the tubal lumen into the canal. FIMBRIAL PLASTIC WITH HOOD

Tutorial Operations to Restore Tubal Patency

Attached to the tubing is a plastic hood which will fit over the reconstructed fimbriated end of the tube. When sutured into position it will serve as a protective barrier to prevent adhesions from the operative area until it has time to heal. The silastic material is prone to pick up lint; the hood should be kept in its container until it is used.

Figure 1. The nurse applies traction on the stay suture on the uterine fundus while the assistant stretches out the tube by holding it with smooth forceps. The surgeon then inserts the polyethylene tubing into the tubal lumen and advances it with a smooth forceps. It need be only long enough to lie comfortably in the distal half of the tube.

Figure 2. The nurse steadies the uterus and the assistant the tube. The surgeon holds the flanged plastic hood between his fingers as he places the first of the sutures which will hold it in place. The suture passes through the outer end of the hood from without inward. It is then led through the interior of the hood and in turn sutured to the cuplike end of the tube. It returns through the hood at a point very close to its site of entry.

Fimbrial plastic with hood

Fimbrial plastic with hood

Figure 3. After placing three sutures in similar fashion the surgeon prepares to advance the hood into its final position. The nurse steadies the uterus with traction on the stay suture. The assistant grasps the tube near the cornual end with forceps while he steadies the outer portion of the tube between thumb and finger just below the newly constructed ostium. The surgeon applies traction to the sutures he has just applied and gently advances the plastic hood in the direction of the tubal opening. When this is impossible, a wire frame that will stretch the bell of the hood can be used.

Fimbrial plastic with hood

Figure 4. With the hood in position all the sutures are tied.

Removal of the Hood

When the surgeon feels that complete healing has taken place and that the danger of adhesions forming around the ostium is over, the plastic hood and polyethylene tubing must be removed. In most instances two or three months are allowed to elapse before the second operation is done.

Figure 5. A stay suture is again placed in the fundus and held on traction to steady it. The assistant holds the tube on tension with a Babcock clamp and thumb forceps while the surgeon gently separates, with fine scissors, any filmy attachments the surface end of the hood may have acquired from the adjacent peritoneum.

Fimbrial plastic with hood

Fimbrial plastic with hood

Figure 6. The sutures which originally held the hood in position are divided.

Figure 7. The plastic hood and the polyethylene tubing are then gently removed. The tubal ostium is now patent and lies free without adhesions or attachments to other structures.

Fimbrial plastic with hood

Fimbrial plastic with hood

 

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