Abstract

PIP: Until the advent of gynecologic microsurgery, tubal infertility surgery was at best viewed by surgeons as a speculative procedure to be performed only on highly motivated women. There was general lack of knowledge of or application for tubal physiology. The practitioner of gynecologic microsurgery however views the oviduct as an anatomically and physiologically complex structure and seeks to preserve or restore functional anatomy. He has evolved a number of ancillary techniques to prevent or minimize trauma of the oviduct and its adnexa, such as: 1) constant irrigation with isotonic balanced salt solutions; 2) precise hemostasis with unipolar or bipolar microcautery; 3) gentle and meticulous handling of tissues; 4) and reperitonization of denuded structures. The oviduct, which averages 10 to 12 cm. in length, is a seromuscular organ consisting of: 1) an outer serous coat, the serosa; 2) a middle smooth muscle coat, the myosalpinx, with outer longitudinal and inner circular layers; and 3) an internal mucus coat, the endosalpinx, composed of ciliated and secretory cells. The oviduct is divided into 4 segments based on characteristic morphologic differences: intramural segment; isthmus; ampulla; and infundibrilum. Patients may be grouped into those suffering from primary or secondary infertility due to a congenitally abnormal or pathologically damaged tubes, and those seeking reversal of prior elective tubal sterilization. Absence of the fimbriae is considered by many clinicians as a contraindication to surgery. The tubal fimbriae function is believed to be a highly specialized and indispensable component of the ovum pick-up mechanism. Fimbriectomy is known to be a very reliable sterilization method, but spontaneous failures are not uncommon primarily due to the formation of tuboperitoneal fistulas that reestablish distal tubal patency. The ampullaryisthmic junction appears to have little functional significance on fertility, as is the uterotubal junction. The shortened tube syndrome or the importance of a minimum length of oviduct necessary for fertility is gaining increasing acceptance. The critical length of tube appears to be approximately 3 cm., but pregnancy has been reported in women with less than 1 cm. of tube remaining. Further research should be done on reproductive function.

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Publication types

• Review

MeSH terms

• Animals
• Fallopian Tubes / anatomy & histology
• Fallopian Tubes / physiology
• Fallopian Tubes / surgery*
• Female
• Humans
• Infertility, Female / surgery
• Microsurgery*
• Pregnancy
• Sterilization Reversal
• Sterilization, Tubal

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