Fimbrioplasty: definition, points of caution, procedure and inconvenience

This option may be performed on women with damage to the fimbriae. If the fimbriae and its cilia are stuck together by scar tissue, which is preventing the ova from being picked up, a fimbrioplasty may be recommended. This procedure rebuilds the fimbriae.

What is fimbrioplasty?

Fimbrioplasty refers to the plastic or reconstructive surgery which aims at repairing the fimbria that may be damaged or cause the fallopian tubes blockage.
What should be noticed during the procedure?

Meticulous hemostasis is absolutely essential if this procedure is to succeed. Care must be exercised not to jeopardize the vascularity of the Fallopian tube by excessive dissection of the mesosalpinx from the ovary. In addition, irrigation, suction, and needlepoint electrocautery should be used to control hemostasis rather than sponging, clamping, and tying of bleeding blood vessels.
What's the operating procedure of the surgery?

1. Before fimbrioplasty, the surgeon should perform a diagnostic laparoscopy.

2. A thorough bimanual pelvic examination is performed.

3. The laparoscopic instruments are introduced as recommended, under Laparoscopy Technique, and the pelvis is thoroughly inspected. If there is gross hydrosalpinx or gross damage to the Fallopian tubes on both sides, it may be wise to abandon the procedure.

4. A Pfannenstiel incision is generally preferred in these cases. Dye marks have been placed to aid closure of the abdomen for a better cosmetic appearance.

5. The abdomen has been opened through the Pfannenstiel incision. Adhesions are found between the Fallopian tube, ovary, and round ligament. The bladder is on the right; the fundus is in the middle. An occlusive Buxton-type clamp is applied to the lower uterine segment, and a 21-gauge needle on a 10-mL syringe filled with indigo carmine solution is inserted through the fundus.

6. Moist packs have been placed in the cul-de-sac to elevate the uterus, tubes, and ovaries into the incision. The microtip cautery is used to remove adhesions. Visual magnification and a source of excellent light are essential if this step is to be performed. The principle of traction/countertraction on the structure is essential to safely demonstrate the adhesions.

7. When the adhesions have been completely removed, the clubbed end of the Fallopian tube can be identified; it should be opened with the cautery on a low setting. Bright light and visual magnification will aid the surgeon in performing this delicate task.

8. A microforceps is used to elevate the serosal layer over the end of the clubbed Fallopian tube. Small vessels are coagulated prior to opening the clubbed end of the fimbriae with the microtip electrical cautery. When the scar tissue over the clubbed end of the tube has been transected, indigo carmine dye will be observed spilling from the Fallopian tube.

9. Microforceps and microscissors are used to pick up the scar tissue and transect the scarred serosal layer covering the fimbriae beneath.

10. Irrigation with warm saline solution can be used to separate the fimbriae and identify the lumen of the ampullar portion of the Fallopian tube.

11. With 7-0 Prolene suture on a microneedle, the scarred serosa is sutured back to the serosa of the Fallopian tube in such a manner as to free the fimbriae and keep the Fallopian tubes patent.

12. To check the patency of the Fallopian tubes, the lower uterine segment is pinched between the thumb and first finger or held with an atraumatic clamp, and a 10-mL syringe on a 21-gauge needle is inserted through the fundus to inject 10 mL of indigo carmine into the endometrial cavity. The dye should fill the Fallopian tubes and spill from the fimbriae.
What's the inconvenience of the surgery?

Very few doctors are experts in this type of procedure and medical insurance often does not cover the cost of this procedure. Fimbrioplasty is now recommended in select cases over salpingostomy, which has been shown to be less successful.