Hysterosalpingogram (HSG), Laparoscopy & Laparotomy

Knowing the condition of the fallopian tubes is essential for proper and effective treatment of fallopian tube blockage. This is because, although you may know your tubes are blocked, you won't know which approach to take in unblocking them unless you have an idea of what type of blockage you have. Each treatment procedure addresses a specific problem hence, your doctor or your treatment provider will need at least, a general view of the condition of your tubes and the location of the blockage to be able to prescribe an appropriate action to take to relieve the blockage. There are generally three tests that are employed in determining the condition of the fallopian tubes -Hysterosalpingogram (HSG), Laparotomy and Laparoscopy. We will discuss each test individually in this article.

Hysterosalpingogram(HSG)
A hysterosalpingogram is also known as a hysterogram or an HSG and is a form of x-ray which provides a visual of the inner part of the uterus(see picture). A special liquid (dye) is injected into the cavity of the uterus which is then observed (through an x-ray of the abdominal area) as it travels into the fallopian tubes. The liquid should be seen to spill out of the ends of the fallopian tubes near the ovaries to conclude the absence of any significant blockage. However, if only some of the liquid drips out of the tube or if not a single drop falls out, a blockage automatically becomes a possibility. However, additional tests would be likely recommended as spasms from the procedure can produce a similar restriction or stoppage in the flow of the liquid from the ends of the tubes. In addition, this type of test is not advisable for pregnant women or for those with infection in the pelvic area (procedure can spread infection through the liquid contrast dye used).

Laparotomy
Laparotomy is also known as coeliotomy and is a procedure used either for diagnostic or therapeutic purposes(see picture). This procedure involves surgery, with incision made through the abdominal wall thereby providing access to the abdominal cavity which houses the organ to be checked or treated. This is an ancient procedure & is not recommended for diagnostic purposes in present-times. Diagnostic laparotomy was generally used to find out what may be wrong with a certain structure in the abdominal cavity (e.g. fallopian tubes). This was a significantly invasive form of diagnostic tool and hence women tend to choose the similar yet less invasive procedure, laparoscopy.

Laparoscopy
Laparoscopy is similar to laparotomy in that, it also involves an incision through the abdomen. However, the incision need only be large enough to accommodate a laparoscope, which is a thin telescope-like instrument (laparoscope) to be used in inspecting the organ with the problem. A visual image of the abdominal cavity and the structures in it is projected in a monitor connected to the laparoscope(see picture). The fallopian tube along with any blockages within it can be seen hence the extent, location and general characteristics of the blockage can be determined. This diagnostic tool provides approximately the same quality of diagnosis as laparotomy and is also used in treatment procedures.

Advantages and Disadvantages
All three diagnostic procedures have their benefits as well as disadvantages. A hysterosalpingogram provides minimal information about the condition of the tube and the risks associated with it makes it unavailable to pregnant women and those with pelvic infections. However, it is non-invasive and cheaper as against the two other procedures.

A laparotomy on the other hand provides the clearest access to checking the condition of the tubes but is largely invasive & is not recommended. Laparoscopy is a less invasive procedure and provides the best quality of diagnosis with a magnified image which helps in both diagnosis as well as therapeutics.