Surgical management of tubal disease and infertility

A spectrum of tubal disease of varying severity is recognised at laparoscopy. Pathology may vary from peritubal adhesions, damaged fimbriae or distorted tubal anatomy to tubal blockage or hydrosalpinx (a fluid-filled distension of the fallopian tube in the presence of distal tubal occlusion). Reproductive surgery remains an important option and complement to assisted reproductive technologies. Reproductive surgery should be considered as first-line treatment: when the correction of infertility pathology is achievable and a good result is expected; when the pathology is causing the patient pain or discomfort; and when if left uncorrected infertility pathology will compromise the results or increase the risks of assisted reproductive technology. The success of surgical infertility treatment depends on the careful selection of cases using appropriate investigative techniques, with procedures performed in centres with sufficient expertise. For both specialised reproductive and general gynaecological surgery, it is paramount to carefully follow the microsurgical principles to avoid adhesion formation and conserve normal tubal and ovarian tissues.