Opportunistic salpingectomy in women undergoing hysterectomy: Results from the HYSTUB randomised controlled trial

Menopausal Symptoms and Surgical Complications After Opportunistic Bilateral Salpingectomy, A Register-based Cohort Study

“…The results up to 8 weeks postsurgery showed a significant difference in hospital stay, with 0.1 day (2 hours and 24 minutes) extra after having had bilateral salpingectomy in addition to hysterectomy. Previous studies have not reported any difference in hospital stay 8,17,26 and our results are, although significant, of uncertain clinical relevance. Perioperative bleeding was slightly reduced in the salpingectomy group and a similar result can be found in a retrospective study by Garcia et al 8 The difference in the amount of blood loss was only 20 mL * Percentage of outcome in hysterectomy with BSE vs hysterectomy only; ** Age-stratified multivariable analysis for menopausal symptoms, adjusted for BMI, parity, smoking, and ASA classification; *** In multivariable model for minor complications potential confounders age, endometriosis, total/subtotal hysterectomy, and previous abdominal surgery were tested but did not fit criteria to be included in final modelen ¼ cases included in model; **** In multivariable model for severe complications potential confounders smoking, previous abdominal surgery, endometriosis, previous salpingitis, and ASA classification were tested but did not fit criteria to be included in final modelen ¼ cases included in model.…”

“…There were no differences in time in surgery, days to normal ADL, and days out of work, which corroborates the findings of several previous studies. 6e8,16e18, 20,26 In summary, bilateral salpingectomy at the time of hysterectomy was associated with an increased risk of menopausal symptoms and there was a tendency toward a higher risk of minor complications 1 year after surgery in this retrospective study. Randomized controlled trials with longer follow-up regarding ovarian function, surgical complications, as well as risk reduction of ovarian cancer are needed to correctly inform women on the risks and benefits of opportunistic salpingectomy.…”

“…31 Studies reporting complications in a shorter time frame (0e6 months) have not shown any increased risk of complications. 7,16,17,21,22,26 McAlpine et al 6 conducted a retrospective cohort study reporting readmission as an indicator of complications and did not reveal any difference between the 2 groups. However, the overall quality of evidence in regards to complications was rated as very low in a recent systematic review by Darelius et al 13 The higher risk of ureter damage after salpingectomy found in this study has to be viewed with caution due to few cases, and the finding needs to be validated in future studies.…”

“…It has been increasingly popular to use AMH to describe ovarian reserve, due to a small intracycle variability and its ability to predict time to menopause. 35 AMH is validated for predicting age at natural menopause but loses accuracy in higher ages according to Depmann et al 35 None of the studies focusing on AMH levels before and after opportunistic salpingectomy show any significant differences in comparison with hysterectomy only, 15,20,22e24,26 but the longest follow-up is only 6 months in a study by Van Lieshout et al 26 The question is if AMH, particularly with a short follow-up, is the accurate measure when assessing the long-term effects of opportunistic salpingectomy. In a meta-analysis by Mohamed et al 33 focusing on AMH before and after bilateral salpingectomy, the authors comment on the short follow-up of existing studies and the small number of studies in the field, and suggest the results should be interpreted with caution.…”

Impact of bilateral total salpingectomy versus standard tubal ligation at time of cesarean section on ovarian reserve: A randomized controlled trial

“…However, they reported prolonged operative time in BTS parturients over BPS participants by 13 min (66.0 ± 20.5 versus 52.3 ± 15.8 minutes, p = 0.01) as well as there were no differences in feasibility and surgical complications [23] . Studies regarding RRS in benign gynecology did not report detrimental impacts on ovarian reserve [35,36,37,38] .…”