Hydrosalpinx: Functional Surgery or Salpingectomy

Background: Hydrosalpinx is a common cause of female infertility1 and adversely affects the outcomes of in vitro fertilization (IVF). Although IVF is the main treatment, alternative treatments, such as salpingectomy and functional tubal surgery have been suggested.2 Previously, hydrosalpinx was diagnosed using tubal patency tests (transvaginal ultrasound, TVUS; hysterosalpingography, HSG; and laparoscopy), which do not assess tubal function hydrosalpinx, and salpingectomy was the main surgical treatment for hydrosalpinx prior to IVF.3 However, with modern tubal endoscopy (salpingoscopy and fertiloscopy)4-7 and their ability to assess tubal functional mucosa, functional tubal surgery can be considered for thin-walled hydrosalpinx and a healthy mucosa and salpingectomy performed for thin-walled hydrosalpinx with mucosal adhesions and thick-walled hydrosalpinx with absent mucosal folds.8 Aims and objectives: The aim of the review is to highlight the use of appropriate tubal function tests to help in making a choice between either salpingectomy or functional tubal surgery as the treatment for hydrosalpinges. Materials and methods: A literature search was performed using the search engine Google, HighWire press, PubMed and SpringerLink. Selected papers were taken for further references. All articles, including randomized controlled trial (RCT) were included for the review. Results: Vasquez et al8 suggested that mucosal adhesions are the most important factors in determining fertility outcomes especially in thin-walled hydrosalpinges. Several studies on hydrosalpinges have also shown that the absence of mucosal adhesions on salpingoscopy can identify patients who can benefit from advantages offered by reconstructive surgery.3-7 Boer Meisel et al9 showed that patients with thin-walled hydrosalpinges and well preserved mucosa had an intrauterine pregnancy rate of 77% and a tubal pregnancy rate of 4% following reconstructive surgery.9 Vasquez et al8 in their prospective study showed that thin-walled hydrosalpinges with a normal or flattened mucosa, but without mucosal adhesions were associated with a 58% pregnancy rate and low risk of tubal pregnancy.8 Their study also found that thick-walled hydrosalpinges with mucosal adhesions have a statistically significant lower intrauterine pregnancy rate.8 Dechaud et al10 showed that salpingectomy for thick-walled hydrosalpinges improved the outcome of IVF. Conclusion: An appropriate tubal mucosal assessment should be a routine prior to deciding upon further management of hydrosalpinx. Functional tubal surgery should be preferred in mild forms of hydrosalpinx and salpingectomy reserved for severe forms of hydrosalpinx.