Feasibility of prophylactic salpingectomy during vaginal hysterectomy

Abstract

BACKGROUND: The American Congress of Obstetricians and Gynecologists recommends that “the surgeon and patient discuss the potential benefits of the removal of the fallopian tubes during a hysterectomy in women at population risk of ovarian cancer who are not having an oophorectomy,” resulting in an increasing rate of salpingectomy at the time of hysterectomy. Rates of salpingectomy are highest for laparoscopic and lowest for vaginal hysterectomy. OBJECTIVE: The primary objective of this study was to determine the feasibility of bilateral salpingectomy at the time of vaginal hysterectomy. Secondary objectives included identification of factors associated with unsuccessful salpingectomy and assessment of its impact on operating time, blood loss, surgical complications, and menopausal symptoms. STUDY DESIGN: This was a multicenter, prospective study of patients undergoing planned vaginal hysterectomy with bilateral salpingectomy. Baseline medical data along with operative findings, operative time, and blood loss for salpingectomy were recorded. Uterine weight and pathology reports for all fallopian tubes were reviewed. Patients completed the Menopause Rating Scale at baseline and at postoperative follow-up. Descriptive analyses were performed to characterize the sample and compare those with successful and unsuccessful completion of planned salpingectomy using Student t test, and χ2 test when appropriate. Questionnaire scores were compared using paired t tests. RESULTS: Among 77 patients offered enrollment, 74 consented (96%), and complete data were available regarding primary outcome for 69 (93%). Mean age was 51 years. Median body mass index was 29.1 kg/m2; median vaginal parity was 2, and 41% were postmenopausal. The indications for hysterectomy included prolapse (78%), heavy menstrual bleeding (20%), and fibroids (11%). When excluding conversions to alternate routes, vaginal salpingectomy was successfully performed in 52/64 (81%) women. Mean operating time for bilateral salpingectomy was 11 (±5.6) minutes, with additional estimated blood loss of 6 (±16.3) mL. There were 8 surgical complications: 3 hemorrhages >500 mL and 5 conversions to alternate routes of surgery, but none of these were due to the salpingectomy. Mean uterine weight was 102 g and there were no malignancies on fallopian tube pathology. Among the 17 patients in whom planned bilateral salpingectomy was not completed, unilateral salpingectomy was performed in 7 patients. Reasons for noncompletion included: tubes high in the pelvis (8), conversion to alternate route for pathology (4), bowel or sidewall adhesions (3), tubes absent (1), and ovarian adhesions (1). Prior adnexal surgery (odds ratio, 2.9; 95% confidence interval, 1.5–5.5; P – .006) and uterine fibroids (odds ratio, 5.8; 95% confidence interval, 1.5–22.5; P = .02) were the only significant factors associated with unsuccessful bilateral salpingectomy. Mean menopause scores improved after successful salpingectomy (12.7 vs 8.6; P < .001). CONCLUSION: Vaginal salpingectomy is feasib...

Factors influencing decision-making around opportunistic salpingectomy: a nationwide survey

“…Therefore, a tailored approach to OS during this type of surgery is comprehensible. Previous research demonstrated OS to be feasible in 81%–88% of vaginal hysterectomies [1225]. However, respondents in our cohort estimated OS to be feasible in approximately half of the cases.…”

“…Several studies investigated this issue, with no difference in ovarian reserve after salpingectomy [789]. Furthermore, there is no evidence for an increased complication rate after OS [68] and literature on surgical time suggests a minor increase of 0–13 minutes, depending on surgical approach [8101112].…”

Factors associated with complications of vaginal hysterectomy in patients with pelvic organ prolapse — a single centre’s experience

“…In another study evaluating salpingo-oophorectomy by the transvaginal route, 127 patients (109 patients with concurrent VH and 18 patients with previous VH) had transvaginal salpingo-oophorectomy, and it was found that complications developed in 9 of the 109 patients (fever, bleeding, ureteral injury, return to operating theatre) [15]. In a multi-centre prospective study evaluating 69 patients who underwent bilateral salpingectomy during VH, Antosh et al [16] reported that mean operating time for bilateral salpingectomy was 11 minutes (± 5.6), with additional estimated blood loss of 6 mL (± 16.3). There were eight surgical complications, none of which was due to the salpingectomy.…”

Prophylactic salpingectomy and ovarian cancer: An evidence-based analysis

“…stated that PBS increases operating time by 11 min and blood loss by 6 ml. [ 17 ] However, it did not increase the complication rate of surgeries. [ 18 ] In Italia, PBS is already well-known among the Italian OBGYNs as the attempt to reduce ovarian cancer incidence.…”