There is no role of hydrotubation after recanalisation ? This practice was given up atleast 2 decades back. Mucosal to mucosal anastomoses should be accurate. Good to use an epidural catheter for cannulation but not a guide wire. Methylene blue testing on the table is practiced and patient is encouraged to conceive in the same cycle. References you will need to search for on pubmed

12 March 2014

Dear Veena,

Thanks for your interesting question !

Exact oppostion can be accomplished between mucosal layers of both sides of the fallopian tube. I have proved this by scanning electron microsopy. We are so overloaded with clinical work in South Africa, that I must still publish this in a reputable medical journal. However, my results have been published in a book I wrote: "Core Obstetrics & Gynaecology with Examination Guidelines for M.B.Ch.B." I have more than 40 years experince of microsurgial tubal anastomosis via a new method micro-laparotomy and using an operating microscope - the proof of results should be live births of healthy babies, which in my experience is more than 90% in isthmus- isthmus tubal anasthomosis. There should be spillage of methylene blue through the fimbrial end of the tube, unless you are experienced enough to realise that you have done a good anastomises, despite leaking of methylene blue at the site of the anastomosis. A guide wire is not necessay for an experienced microsurgeon, with the exception of interstial anastomosis - the fallopian tubes are so narrow here that I a have used prolene 0 as a guideline to ensure proper and accurate anastomisis. The gudeline wire can easily be removed via hysteroscopy, before the woman leaves the hospital. This has greatly inproved results in these cases, in my experience. I only came to this conclusion after repeating operations, which I no longer find necessary.

With proper operative technique postoperative managemet should consist of that usually practised, with the exception of hysteroscopy as I mentioned. Although not properly researched, post-operative antibiotics should be given, since tubal structure is so delicate, that even a minor infection can destroy the operation (tubal cilia and microvilli).

In my experience there is no place for postoperative hydrotubation and little place for post-operative laporosopy/ post-operative hysterosalpinography. It is a waste of time and money, since better observations can be made by pre-operative laparoscopy and hysteroscopy and in exeptional cases post-operative laporoscopy, if the patient is not pregnant after a year. Obviously ovulation should be evaluated by temperature charts, etc., as well as male infertilty/impotence.

Laporoscopic anastomosis has many disadvantages as compared to minmal access minmal invasive microsurgery.

Likewise IVF should not be used for operable cases, since the results are much poorer when expressed as the birth of live healtty babies. Unfortunatelely IVF specialists persist in reporting their results as pregnancies per cycle, meaning a positive beta -HCG. However the vast majority of patients with a positive beta- HCG abort.

This is only a short answer to a vast subject - I will gladly answer more questions.

Prof J T Nel.

There is no role of hydrotubation after recanalisation. Stenting is useful.

Ganesh Dangal

Thanks for everybody's comments. Since muscularis layer of the tubes is approximated during the procedure, can one be sure about exact mucosa to mucosa anastomosis? In case there is no spillageof Methylene blue through the fimbrail end following the anastomosis, one cannot redo the surgery. In that context, is there any point in doing chromopertubation, after the surgery at all?

I recently performed a tubal reanastomosis, , and a succesful procedure with a live birth following that , i feel that hydrotubation is not required . i left a guide wire using prolene 1 in both tubes and removed after 21 days , however i feel that a tubal patency test after six months might be useful . what do you say

With experience and using an operating microscope, muscularis approximation results in exact mucosa to mucosa approximation. Sutures should not be placed through mucosa, since this may result in ectopic pregnancy. I agree with Dr. Bakul Leuva - 10x magnification is sufficient. Loupes have the disadvantage that the surgeon has to move his/her head during the operation, in contrast to an operating microscope which can be focused and tilted by foot pedals. Constant movement of head and neck can be very tiresome. Kind regards, Johan (JT) Nel.

I wish to add: if there is spillage of e g methylene blue at the site of tubal anastomosis, the patency of the distal tube can be acertained by gently injecting methylene blue from the fimbrial end of the Fallopian tube(s). A small intracath connected to a syringe filled with methylene blue can be used to do this.

Kind regards,

Prof J T Nel.

Dear madam there is no role of Hydrotubation ,long back it has given up.mucosal to mucosal anastomosis is possible, in narrow areas like isthmic anastomosis one can make use of  microscopes. just fine probes can give idea of the lumen. laparoscopy is agood option.methylene blue test is in practice.

Today we do few tubal reanastomosis because our IVF Programm. But in those cases we use DR. Dubuisson JB "one stitch technique by laparoscopy" Hum Reprod. 1995 Aug;10(8):2044-6; without methilene blue test after surgery because high pressure into the tube with fine sutures is not good; without hydrotubations and if we need to look at an HSG three months after reanastomosis by laparoscopy