Unilateral / Bilateral Salpingectomy

Salpingectomy surgery is a procedure to remove a Fallopian tube. Your doctor may recommend having your Fallopian tube(s) removed as a treatment for fertility problems or tubal disease, including cancer or infection.

The Fallopian tubes are the two narrow tunnels extending from the uterus to the two ovaries. During menstruation, an egg is released from the ovaries and guided into the Fallopian tubes by the tiny finger-like fimbriae. The egg then travels through the Fallopian tube into the uterus. An egg can either be fertilized by a sperm in the Fallopian tube, prompting a pregnancy, or it will be shed with the uterine lining during the woman’s next period.

Removal of both Fallopian tubes makes natural conception impossible but other fertility options, such as in-vitro fertilization (IVF), may still be available. Some patients may be able to preserve their Fallopian tubes with an alternative tubal surgery.​

Salpingostomy and Fimbrioplasty

Some patients may need intensive treatment for Fallopian tube diseases, but may still wish to conceive naturally. As an alternative to removal of the fallopian tube, some doctors may recommend fallopian tube reconstruction.​

Salpingostomy

A salpingostomy involves removing a blockage or creating a new opening – also known as a stoma – for the Fallopian tube. It is often used when a patient’s tubes have been damaged by disease, a past surgery, or adhesions. Adhesions are areas of scar tissue that cause organs to stick together.​

Fimbrioplasty

Most salpingostomies will be performed along with a fimbrioplasty, which is a reconstructive procedure to salvage the tiny, delicate fimbriae. The fringe-like fimbriae guide a ripened egg toward the opening of the fallopian tube. Preservation of the fimbriae increases fertility for women who wish to conceive naturally.

Not every patient is a good candidate for tubal reconstruction surgery. Your doctor may not recommend this type of treatment for women who have:

  • Chlamydia
  • Stage 3 or 4 tubal cancer
  • Severe adhesions
  • A history of ectopic pregnancy
  • A previous salpingostomy​

What Conditions can a Salpingectomy Treat

  • A salpingectomy or salpingostomy can be performed to treat several serious gynecological conditions.
  • Tubal cancer or tumors
  • Endometriosis
  • Infection due to sexually transmitted or other diseases
  • Tubal adhesions
  • Scarring or blockage due to previous tubal surgery
  • Ectopic pregnancy
  • Ruptured fallopian tube
  • Hydrosalpinx​

Infertility. Although it may seem counter-intuitive, removing one or both Fallopian tubes can often lead to better fertility outcomes than repairing the tubes. For some infertile women, having a salpingectomy has been shown to increase the chances of implantation via IVF. Furthermore, defective Fallopian tubes may put you at risk for ectopic pregnancy or adhesions.

Unilateral / Bilateral Oophorectomy

An oophorectomy is the surgical removal of one or both ovaries.

Ovarian Hormones include: estrogen and progesterone & testosterone.
Most patients will continue to menstruate and could conceive naturally following unilateral or one-sided oophorectomy.​

Conditions that Oophorectomy Treats:

  • Ovarian cancer & precancerous risks
  • Noncancerous ovarian tumors
  • Ovarian cysts
  • Tubo-ovarian abscesses
  • Ovarian torsion & necrotic adnexa
  • Endometriosis​

The procedure of bilateral oophorectomy in reproductive age group leads to the sudden onset of menopause often called “surgical menopause”.
​Infertility and hormonal changes associated with this procedure should be fully discussed with your physician.

  • ​Abdominal oophorectomy -rarely performed.
  • Laparoscopic Oophorectomy-most common type.
  • Robotic-assisted laparoscopic Oopherectomy Procedure: same as laparoscopy with robotic assistance that requires expensive equipment

​Recovery is dependent on type with laparoscopy being performed on an outpatient basis.

Diagnostic Laparoscopy +/- Extensive Adhesiolysis, +/- Chromotubation

A laparoscope is a thin, flexible tube with a lighted lens at the end. When inserted into the body which allows video visualisation with magnification abilities of the

internal organs:

  • Uterus
  • Fallopian tubes
  • Ovaries
  • Bladder
  • Ureters
  • Bowel
  • Peritoneum
  • Stomach
  • Liver
  • Gallbladder
  • Appendix
  • Omentum
  • Diaphragms

Think of Laparoscopy as a minimally invasive imaging & operative diagnostic tools.performed under general anesthesia and usually in an outpatient setting.

Risks of Diagnostic Laparoscopy:

  • Infection
  • Damage to: uterus, fallopian tubes, ovaries, bowel, or bladder.
  • Possible scarring (adhesions)
  • Bleeding​

Adhesiolysis or divisions of tissue scarring:

May alleviate pains of pelvic pain, infertility, bowel problems, and obstructions and must be performed by an experienced surgeon with preoperative bowel preps. laparoscopic procedures inherently have lower adhesion risks compared to laparotomies.

Chromotubation:

During Laparoscopy a uterine manipulator is inserted in the endometrial cavity and a blue dye is pushed through the vaginal end to observe spillage from fimbriated tubal ends into the pelvic cavity. This procedure can diagnose intrauterine intratubular obstruction or partial blockage. Patient must be screened for sexually transmitted diseases such as Gonorrhea and Chlamydia to reduce risks of pelvic inflammatory abscess formation.

Patients have a higher likelihood of spontaneous conception in the first two cycles post chromotubation.

Laparoscopic Myomectomy

Myomectomy or removal of uterine fibroids aims to treat symptoms of uterine fibroids while preserving fertility.

Symptoms that can be treated by Myomectomy:

  • Anemia due to heavier and irregular bleeding caused by fibroids
  • Pelvic pain and pressure
  • Infertility or recurring miscarriages
  • Urinary or bowel issues caused by fibroids​

Minimally invasive Operations for Myomectomies:

  • Laparoscopy
  • Hysteroscopy​

Abdominal hysterectomy has longer recovery time but might be a surgeon’s preferred option at times.​

Risks of Myomectomy:

  • Damage to adjacent organs: uterus, fallopian tubes, ovaries, bladder, bowel & ureters
  • Scarring & infertility
  • Need for cesarean delivery at subsequent pregnancy
  • Infection
  • Excessive hemorrhage
  • Hysterectomy
  • Reoccuring fibroids​

Myomectomy Recovery

  • Abdominal – 3-4 days in the hospital, 6 weeks recovery
  • Laparoscopy – 0-1 days in the hospital, 2 weeks recovery
  • Hysteroscopy – No hospital stay, 1 week recovery

Vaginal & Uterine Septum Corrective Surgery

Congenital Vaginal Abnormalities usually are undiagnosed till later in life and mostly uncommon in nature and the majority of cases involve the development of a septum that separates an anatomical cavity. The tissue separating your nasal cavity into two nostrils is one example of a septum. Most commonly recognized via MRI imaging.​

Types of Vaginal septum:​

Transverse septum:(a complete or incomplete division of Uterine cavity to top & bottom halves, extremely rare) Symptoms usually appear at puberty and may result in retrograde menstruation, endometriosis and present with:

  • Pelvic & Back pain
  • Difficulty with intercourse
  • Urinary symptoms
  • Abdominal swelling​

Longitudinal Septums: Double vertical duplication and in instances with two cervices & vagina.Usually present with:​

  • Dysmenorrhea
  • Abnormal uterine bleeding
  • Pain with intercourse​

Pregnancy complications:​

  • Infertility
  • Miscarriage
  • Premature birth
  • preterm labor
  • Intrauterine growth retardation(IUGR)​

Surgical correction with septoplasty depending on findings might be the recommended procedure and we specialize in these operations.

Dilation and Curettage (D&C)

Dilation and Curettage (D&C) is an operation that scrapes the uterine cavity lining for several reasons:

  • completing an ongoing miscarriage
  • Evacuation of retained placental tissue
  • Abortion procedures(illegal in UAE)
  • Diagnosing causes of Abnormal bleeding
  • Removal of uterine polyps
  • Uterine cancer detection
  • Fertility-related procedure​D&C surgery:
  • Mostly same day procedure
  • Local or General Anesthesia
  • Risks of: Uterine perforation, bleeding, transfusion, damage to adjacent organs, scarring and future infertility-Asherman’s Syndrome
  • Cervix is gently dilated
  • Curettage is done as Suction or sharp
  • Ultrasound guidance can be used​

Recovery:

  • Panadol and or Voltaren
  • Occasionally antibiotics are given
  • Expect to cramp
  • Expect to spot
  • Abstain from sex x2 weeks
  • No swimming x 2 weeks
  • No driving x 24 hours

An ectopic pregnancy occurs when a fertilized egg implants itself outside of the uterus. They’re also called “tubal pregnancies” because most of them happen in the

fallopian tubes. Whether there’s a problem with the egg or the tube, the egg gets stuck on its journey to the uterus.

A pregnancy can’t survive outside of the uterus, so all ectopic pregnancies must end. It used to be that about 90% of women with ectopic pregnancies had to have surgery. Today, the number of surgeries is much lower, and many more ectopic pregnancies are managed with medication that prevents them from progressing.

If you’re diagnosed with an ectopic pregnancy, how your doctor will treat it depends on how far the pregnancy has progressed, where the embryo is, and how severe your symptoms are.

​​
Laparoscopic Management for Ectopic Pregnancy

If methotrexate therapy doesn’t work, surgery is the next step. It’s also the only option for women with high hCG levels, severe symptoms, and ruptured or damaged fallopian tubes.

You may have laparoscopic surgery that involves a very small cut, a tiny camera, and no damage to your fallopian tube. Surgeons prefer to use this method rather than doing surgery with a larger cut. But sometimes that’s not possible. If your tube has ruptured or been severely damaged and you’ve had severe bleeding, you’ll probably need emergency surgery with the bigger incision. In these situations, the surgeons might have to remove your fallopian tube.

After surgery, your doctors will watch your hCG levels to make sure they’re going down and the pregnancy was removed properly. Some women also need a methotrexate injection so everything returns to normal.

Leep Procedure & Cold Knife Cone Biopsy

Treating cervical dysplasia is done most commonly via:

Cold knife cone biopsy (out patient under general anesthesia)

Loop Electrosurgical Excisions Procedure (LEEP Procedure) can be done in office or as outpatient surgery under paracervical block anesthesia or general anesthesia.

Pathologic types:

  • CIN I – Mild dysplasia
  • CIN II – Moderate dysplasia
  • CIN III – Severe dysplasia or carcinoma

Specific risks associated with LEEP or Cold Knife surgery:

  • Infection
  • Bleeding
  • Adjacent organ damage: Bowel/Bladder/Urethra/Vaginal wall
  • Cervical Incompetence leading to early miscarriage
  • Cervical insufficiencies leading to premature deliveries
  • Cervical stenossis & scarring resulting infertility

Expected recovery:

  • Mild cramping.
  • Vaginal discharge for 1-3 weeks
  • Discharge that is dark or brown in color
  • Abstain from sexual intercourse and use pads instead of tampons to absorb blood. Douching is not recommended.
  • Contact your OB/GYN if you are experiencing:
  • Fever, nausea
  • Foul-smelling discharge
  • Worsening pain
  • Severe bleeding or clotting
  • More frequent follow ups for the next two years is imperative for best outcome.

TVT / TVT-O Continence Surgery

  • TVT: Tension-free Vaginal Tape (Prolene)
  • TVT-O:Tension-free vaginal tape-obturator

The result at 5 years is 85% cure, 10% improved and 5% failure.

  • Outpatient
  • low downtime
  • less pain
  • Better success

​Risks are comparable to all other operations of incontinence repair with the addition of tape erosion and rejection.​

Follow-Up Visits

  • 1 Week
  • 1 Month
  • 6 Months​

TVT / TVT-O Continence Surgery:

  • TVT: Tension-free Vaginal Tape (Prolene)
  • TVT-O:Tension-free vaginal tape-obturator​

The result at 5 years is 85% cure, 10% improved and 5% failure.

  • Outpatient
  • low downtime
  • less pain
  • Better success​

Risks are comparable to all other operations of incontinence repair with the addition of tape erosion and rejection.​

Follow-Up Visits

  • 1 Week
  • 1 Month
  • 6 Months

Pelvic Organ Prolapse

Pelvic organ prolapse occurs due to lack or reduced support and results in anatomical abnormalities of following organs:

  • Bladder
  • Rectum
  • Uterus
  • Vaginal Vault, following a hysterectomy
  • small intestines(enterocele)
  • Pelvic organ prolapse can range from mild to severe.​

Symptoms of prolapse are:

  • Pressure And pain
  • Difficult urination or bowel movements
  • Pain or discomfort during sex
  • Palpable protrusion of tissue through the vagina​

Pelvic Prolapse Treatment:

  • Pessary: A pessary is a small, doughnut-shaped device made out of plastic or rubber that can be inserted into the vagina.
  • Kegel exercises: Perform 20 repetitions of this exercise 3-5 times per day.
  • Weight loss
  • Surgery:Obliterative surgery or Reconstructive
  • Sacrospinous ligament fixation
  • Colporrhaphy, anterior & posterior
  • Sacrocolpopexy
  • Vaginal mesh

Recovery from Reconstructive Surgery
4-6 weeks