The management of hydrosalpinges: tubal surgery or salpingectomy?
OBJECTIVE
The clinical management of hydrosalpinges in infertile patients remains a contentious issue. This review aims to provide a critical analysis on the available treatments for hydrosalpinges, which have recently created a fierce debate between the promoters of salpingectomy and in-vitro fertilization and those who endorse tubal surgery.


RESULTS
Hydrosalpinges have a detrimental effect on the outcome of in-vitro fertilization yet their mechanism is still unclear. Salpingectomy prior to in-vitro fertilization restores the likelihood of a successful outcome in a well defined group of patients with ultrasound-visible hydrosalpinges. However, not every woman with large hydrosalpinges should undergo salpingectomy as some fallopian tubes may be amenable to surgical repair. Preserved tubal mucosa indicates a good prognosis for tubal surgery, therefore an appropriate mucosal assessment should be routine prior to deciding upon further management.


CONCLUSIONS
As salpingectomy is a definitive procedure it should be performed when the hydrosalpinges are beyond repair or in cases of in-vitro fertilization failure. Tubal surgery should be preferred to salpingectomy in mild to moderate tubal disease. A comparative study of restorative tubal surgery versus salpingectomy and in-vitro fertilization in selected women with hydrosalpinges is needed and will significantly help this debate. Prophylactic salpingectomy prior to in-vitro fertilization and tubal surgery is not competing but complementary in the treatment of hydrosalpinges-related infertility.
Centre for Reproductive Medicine & Surgery, Department of Obstetrics and Gynecology, St Bartholomew's Hospital, West Smithfield, London, UK. luca.sabatini@bartsanthelondon.nhs.uk
Luca
L
Sabatini
Colin
C
Davis
D005184:Fallopian Tube Diseases / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D005187:Fallopian Tubes / Q000473:pathology / Q000601:surgery*; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D007247:Infertility, Female / Q000209:etiology / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic