Failed salpingectomy: Hi Ladies, I had a... - Endometriosis UK

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Failed salpingectomy

DSan profile image
DSan
2 Replies

Hi Ladies,

I had a laparoscopy early September to remove both my tubes which are blocked by endometriosis to give the next cycle of ivf a chance to work. With my first cycle, the consultant found fluid had leaked into my uterus from the damaged tubes which probably prevented the embryo from implanting so suggested I had both tubes removed.

Had an hsg done a few weeks ago only to find the left tube still connected. The surgeon who operated on me said the tube was totally buried in adhesions with my bowel and was extremely difficult to locate. He cut something out which he thought could have been the tube but turned out not to be.

He said the options available to me are that I have radical bowel surgery done to separate the tube from my bowel resulting in a temporary stoma or I have a stent put in my tube_ a thing called Essure to block the tube which is basically a metal coil made of nickel, this procedure is usually used for sterilization but is relatively new with not such a great success rate. Has anyone heard of/tried this?

I'm at such a loss. Would really appreciate advice from anyone who has been in a similar situation. Thanks x

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Impatient profile image
Impatient

Did you read the FAQs on the website for essure?

Is Essure right for me?

Essure might be right for you if:

You are certain you do not want any more children

You desire permanent birth control

You prefer a method or procedure that:

Does not take a lot of time

Does not require surgery or general anesthesia

Does not contain hormones

Essure is NOT right for you if: [***** This bit is relevant because you do only have 1 tube and there is some obstruction****]

You have only one fallopian tube

You have one or both fallopian tubes closed or obstructed

You have had your “tubes tied” (tubal ligation)

You are allergic to contrast dye used during X-ray exams

You are unwilling to undergo the Essure Confirmation Test

You are uncertain about ending your fertility

Indication

Essure is a permanent birth control procedure that works with your body to create a natural barrier against pregnancy.

Important Safety Information

WARNING: You must continue to use another form of birth control until you have your Essure Confirmation Test and your doctor tells you that you can rely on Essure for birth control.

You can rely on Essure for birth control only after your doctor has reviewed your Essure Confirmation Test results. Your doctor will confirm that the inserts are properly placed and both of your fallopian tubes are blocked. If you rely on Essure for birth control before having your Essure Confirmation Test, you are at risk of getting pregnant.

Talk to your doctor about which method of birth control you should use for the 3 months after the procedure. Some women can remain on their current birth control. Other women, such as those using an intrauterine device or contraceptive (IUD or IUC), will need to switch to another method.

It can take longer than three months for the Essure procedure to be effective. In rare cases, it has taken up to 6 months. Make sure to continue using an alternate form of birth control up until your doctor has reviewed your Essure Confirmation Test results and confirmed that you can rely on Essure for birth control.

WARNING: Be sure you are done having children before you undergo the Essure procedure. Essure is a permanent method of birth control. The younger a woman is when she chooses to end her fertility, the more likely she is to regret her choice later.

During the procedure: You may experience mild to moderate pain, your doctor may be unable to place one or both Essure inserts correctly, part of an Essure insert may break off or puncture the fallopian tube requiring surgery to repair the puncture, or your body may absorb a large amount of the salt water solution. Your doctor may recommend a local anesthesia which numbs the cervix. Ask your doctor about the risks associated with this type of anesthesia. Immediately following the procedure: You may experience mild to moderate pain and/or cramping, vaginal bleeding, and pelvic or back discomfort for a few days. Some women experience nausea and/or vomiting or fainting. In rare instances, an Essure insert may be expelled from the body. During the Essure Confirmation Test: You will be exposed to very low levels of radiation, as with most x-rays. In rare instances, women may experience spotting and/or infection.

Long-term Risks: There are rare reports of chronic pelvic pain in women who have had Essure. In rare instances, an Essure insert may migrate through the fallopian tubes into the lower abdomen and pelvis. It may be necessary to surgically remove the migrated device if the patient is experiencing an adverse event. No birth control method is 100% effective. If you do become pregnant after Essure, the risks to you, the fetus, the pregnancy and childbirth are unknown. Women who have the Essure procedure are more likely to have an ectopic pregnancy if they get pregnant. Ectopic pregnancy is when the pregnancy occurs outside of the uterus. Ectopic pregnancies can be very serious or life-threatening. If you have the NovaSure® procedure, a procedure that removes the lining of the uterus to lighten or stop menstrual bleeding, after the Essure procedure, your risk of pregnancy may increase. The Essure insert is made of materials that include a nickel-titanium alloy. Patients who are allergic to nickel may have an allergic reaction to the inserts. Symptoms include rash, itching and hives.

Unknown Risks: The safety and effectiveness of Essure has not been established in women under 21 or over 45 years old. The safety and effectiveness of reversing the Essure procedure, of in vitro fertilization (IVF) after the procedure, or to you and your fetus if you get pregnant after the procedure are not known.

Adverse Events: During the procedure, the most common problem reported was mild to moderate pain (9.3%). Some of the women in the study reported moderate pain (12.9%) and/or cramping (29.6%) on the day of the procedure. A smaller percentage of women reported nausea/vomiting (10.8%) and vaginal bleeding (6.8%).

Essure inserts do not protect against HIV or other sexually transmitted diseases.

Talk to your doctor about the Essure procedure and whether it is right for you.

You are encouraged to report negative side effects or quality complaints of prescription drugs to the FDA. Visit fda.gov/medwatch, or call 1‑800‑FDA‑1088.

You can also report any adverse events or product technical complaints involving the Essure system immediately by calling 877-ESSURE1 (877-377-8731).

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In my case I have an extreme allergy to Nickel - so I wouldn't be able to risk this beast at all. It would probably see me in an early grave.

If you get dermatitis skin blistering or weeping reaction to junk jewellery - non-silver or gold earrings cause a reaction on the earlobes or you get a rash round the neck from wearing junk metal necklaces for example then you probably have a nickel allergy.

This type of allergy can be cumulative and over time each new exposure cause a more severe reaction to the previous one. It's very easy to test for a nickel allergy and so many of us do have them. Be sure to make sure you have no nickel allergy before even considering this essure option. So any ladies with endo have sensitive skin allergies including nickel.

Essure is not so new - 2002 was when it was first FDA approved, but you can read about that on the FAQ webpage. essure.com/faq

but also read MANY of the 1st hand experiences on essureprocedure.net/categor...

essureprocedure.net/

and google for other cases using 'essure' and 'side effects'.

I am no expert but the risks seem extremely high for this product, and your need for it would appear to be to block the passage of fluid from the hydrosalpinx to the uterus. I wonder if instead of the essure it might not be better to get the tube tied closer to the uterus where it isn't attached to the bowel?

There is a risk of bowel complications and needing a stoma - as there is with most RV endo surgery you do need to be warned of that risk - but I would definitely ask for a second surgical opinion on this, and a rough percentage risk of the need for a stoma and whether it is a reversible or permanent one that would be likely?

Adhesiology (the removal of adhesions) can be a complex op needing to be done by a highly skilled/trained surgeon to lower the risks of complications.

Definitely time to research this and do lots of homework and most definitely seek out at least one more surgical opinion from a highly trained surgeon in this field.

If you are not yet with an accredited endo centre - take a look on the BSGE website for your nearest and look to see who the colorectal surgeon is and perhaps ask your GP to refer you to them for an opinion too. You can see surgeons privately if the NHS budget doesn't stretch to too many second opinion consultations.

Appointments usually cost bout £300.

It is however essential that you do seek out medical advice on this situation whatever it may cost you initially if it could result in a pregnancy or could leave you in agony for years.

It certainly isn't a straightforward dilemma to figure out. Very best of luck coming to a decision.

Either of the two options offered you so far will be delaying your IVF for several months, so from a time perspective there doesn't seem much of a difference - either waiting for essure to get to work or recovering from a surgery.

And furthermore - is the essure just intended to be temporary solution for one pregnancy followed by surgery anyway at later date to remove the fallopian tube?

You also need to be asking if the tube is so deeply imbedded with the bowel and you have essure but not surgery to remove or detach the tube from the uterus, what ways will that impact on the pregnancy and growing baby bump?

Adhesions are super glue strong, so would the expanding uterus be likely to cause you considerable pains throughout the pregnancy as well as possible difficulties with bowel action if in the event of not having surgery and opting for essure you do end up pregnant after IVF?

You need be aware that the risks of an ectopic pregnancy are higher if you have essure.

You also need to be aware that essure pokes into the uterine cavity and could harm an IVF pregnancy mayoclinic.org/tests-proced...

abc15.com/news/local-news/i...

google.co.uk/url?sa=t&rct=j...

asrm.org/detail.aspx?id=6953

hugu.sescam.jccm.es/media/d...

dailymail.co.uk/femail/arti...

So much to read - do make sure you take time - read up, save the important websites in favourites so you can refer back to then easily if needed. All the best for whatever you decide to do.

In the event of not wanting to risk essure and IVF or surgery - don't forget to look for surrogacy as an option too. It doesn't have to be someone you know, there are women who volunteer to be surrogates. Read through the COTS website to understand the pros and cons surrogacy.org.uk/About_COTS...

DSan profile image
DSan in reply to Impatient

Thanks so much for your reply impatient and for taking the time to dig out the information on Essure. I too have an allergy to nickel so I think that would be a major cause for concern along with everything else.

The surgeon I am with is BSGE accredited but as he himself has said, he's not a fertility expert. I have booked an appointment with the ivf consultant in a couple of weeks and I am hoping that he will offer me another solution. I vaguely remember him saying that if a tube is damaged and it is not possible to detach the tube then it may be possible to drain the tube and give antibiotics at the time that the embryos are put back. I am so hoping that this will be the case for me. If not, I will definitely ask whether it is possible to detach the tube nearer the uterus rather than the other end, however the surgeon did say that my bowel is wrapped around my left tube.

Anyway, thanks you again for your suggestions and the information.

All the best to you. Xx

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