hydrosalphinx in accumulation fluid in fallopian tube that make problems for sperm to pass through the tube to meet te oocyte. People who want to get pregnant should meet the doctor to solve this problem. pregnancy can achieve after operation by laparoscopic for diagnostic and treatment

1. HYDROSALPHINX
Rika Effendy

2. Hydrosalpinx
• Hydrosalpinx  collection of watery fluid in the uterine tube
• Main cause :
PID is most frequently Chlamydia trachomatis, followed by
gonorrhea and multibacterial infections. Some degree of
endometriosis is found in up to 50% of infertility laparoscopies.
Tuberculosis of the fallopian tubes is exceedingly rare
J. Donnez, P Jadoul, M Smets, and J. Squifflet
Atlas of operative Laparoscopy and Hysteroscopy,2017 p.
141-157

3. Hydrosalpinx simplex – excessive distension and
thinning of the uterine tube wall, tubal plicae are thin
and widely separated.
• Hydrosalpinx follicularis – tube without any central
cystic cavity, the lumen being broken up into
compartments, plicae are fused (it covers also
cases without any fluid in tubes).
• Saktosalpinx – dilation of the inflamed uterine tube
by retained secretions (saktos = stuffed).
Ajouma LC et al, Hum Reprod 2002; 8: 255‐2
Peter B. Greenspan, 2018

4. Sonohysterography
Sensitivity of
90,4%
Specificity
70,2 %
Compare to
laparoscopy
Transvaginal
U/S
Better evaluation of the volume of dilatation tube
Hysterosalpingography
Sensitivity 65 %
Specificity 83 %
Compare to laparoscopy
Diagnosis of
Hydrosalpinx
Laparoscopic is a gold standart
Ajouma LC et al, Hum Reprod 2002; 8: 255‐2
Peter B. Greenspan, 2018

5. Laparoscopy with chromotubation
Ajouma LC et al, Hum Reprod 2002; 8: 255‐2
Peter B. Greenspan, 2018
The presence of hydrosalpinx can be diagnosed by a
hysterosalpingogram or by laparoscopy with
or without chromopertubation. A meta-analysis of all the
studies comparing hysterosalpingography with the gold
standard of laparoscopy with chromopertubation showed
the hysterosalpingogram to have a sensitivity of 65% and a
specificity of 83% in the diagnosis of tubal obstruction13,14

6. Is Surgical Repair of the Fallopian Tubes Ever
Appropriate?
Factors contributing to the establishment of a prognosis for surgery can be subdivided into two groups:
tubal and extratubal factors.
Tubal factors to be considered are:
• Ampullary dilatation
• Preservation of the ampullary folds
• Detection of intratubal adhesions
• Macroscopic and microscopic mucosal tubal status
J. Donnez, P Jadoul, M Smets, and J. Squifflet
Atlas of operative Laparoscopy and Hysteroscopy,2017 p.
141-157

7. J. Donnez, P Jadoul, M Smets, and J. Squifflet
Atlas of operative Laparoscopy and Hysteroscopy,2017 p. 141-157
• Morphology of Tubal Damage Fallopian tube damage can take several forms:
1. Proximal occlusion: Obliterative fibrosis, salpingitis isthmica nodosa, tubal polyps,
cornual fibroids
2. Midsegment occlusion: Segmental salpingectomy for sterilization or for ectopic
pregnancy, congenital segmental absence
3. Distal tubal occlusion
• Nonocclusive, preserved fimbria: Fimbrial agglutination, mild prefimbrial
phimosis, perifimbrial adhesions
• Occlusive, absent fimbria: Hydrosalpinx, post–distal salpingectomy for
sterilization or ectopic pregnancy Diagnosis and presurgical evaluation of
tubal infertility traditionally includes a hysterosalpingogram (HSG) and
laparoscopic chromopertubation, with optional sonohysterography,
salpingoscopy/falloposcopy, and Chlamydia serology.

8. Classification of distal tubal occlusion by
Donnez and Casanas-Roux
• Degree I : Phymotic ostium with preserved tubal patency
• Degree II : Total distal tubal occlusion without ampullary dilatation
• Degree III : Ampullary dilatation inferior to 2.5 cm; ampullary folds well-
preserved
• Degree IV : Hydrosalpinx simplex; dilatation more than 2.5 cm; well-
preserved ampullary folds
• Degree V : Thick-walled hydrosalpinx; absence of ampullary folds
J. Donnez, P Jadoul, M Smets, and J. Squifflet
Atlas of operative Laparoscopy and Hysteroscopy,2017 p. 141-157

9. Hydrosalpinx classification by Boer-Meisel
1) Normal mucosa; regular patterns of lush mucosal folds, richly
vascularized
2) Hydrosalpinx with moderate attenuation of mucosal folds; patches of
normal mucosa
3) Absence of ampullary folds; honeycomb aspect
J. Donnez, P Jadoul, M Smets, and J. Squifflet
Atlas of operative Laparoscopy and Hysteroscopy,2017 p.
141-157

10. Salpingostomy
• Salpingostomy is more suitable and beneficial for patients with mild tubal
disease.
• The efficacy of the operation is low for patients suffering from a severe tubal
demage/hydrosalpinx.
• The re-opening of the tubes may also increase the risk of having ectopic
pregnancy. Some patients experience recurrence of hydrosalpinx after surgery
as the scar tissue reforms causing blockage again.
J. Donnez, P Jadoul, M Smets, and J. Squifflet
Atlas of operative Laparoscopy and Hysteroscopy,2017 p. 141-157

11. salpingectomy
salpingectomy is the most effective way of avoiding the tubal fluid flowing
into the uterine cavity.
if the patient has severe adhesions near the tubes, and the anticipated
chance of surgical complications is high by performing salpingectomy, the
doctor may consider performing proximal tubal blocking.
J. Donnez, P Jadoul, M Smets, and J. Squifflet
Atlas of operative Laparoscopy and Hysteroscopy,2017 p.
141-157

12. TECHNIQUES
• Tubal occlusion: degree I
Fimbrioplasty is also carried out during laparoscopy. When fimbrial adhesions
are found as the blue dye begins to spill out through the open tube, these
adhesions between the fimbrial folds
• Tubal occlusion: degrees II, III and IV
Salpingostomy can be performed with the CO2 laser, and is indicated in cases of
thin-walled hydrosalpinx where both proximal tubal patency and the presence of
ampullary folds have been confirmed by a hysterosalpingogram
• Tubal occlusion: degree V
In the case of thick-walled hydrosalpinx, the ampullary folds are absent. The
pregnancy rate after microsurgery10 is 0%; for this reason, there is no indication
for salpingostomy.
P Jadoul, J Donnesz, Atlas of Operatif Laparoscopy and Hysteroscopy 3rd Ed, 2007

13. Thank you