Postpartum Salpingectomy Compared With Standard Tubal Ligation After Vaginal Delivery

Abstract

OBJECTIVE: To compare operative outcomes of postpartum salpingectomy and tubal ligation after vaginal delivery. METHODS: This retrospective cohort study identified patients who underwent tubal sterilization between January 1, 2009, and December 31, 2019, at a large academic hospital, using the electronic medical record. All patients who delivered vaginally and underwent tubal sterilization during their delivery admissions were included. The primary outcome was total operative time. Secondary outcomes included estimated blood loss, perioperative complications, and readmission within 6 weeks postpartum. Patients who underwent bilateral tubal ligation were compared with those who underwent bilateral salpingectomy using Pearson's χ2 test, Fisher exact, and Student's t test. RESULTS: A total of 317 eligible patients were identified. One hundred and six (94%) salpingectomies were completed using a bipolar electrocautery device. Operative time was 3 minutes shorter in the salpingectomy group, 30 minutes (interquartile range 24–38) compared with 33.5 (26–42) minutes, P=.032. Patients who underwent salpingectomy were more likely to have estimated blood loss of 5 mL or less (our institutional shorthand for minimal blood loss) than women who underwent bilateral tubal ligation (78 [69%] vs 112 [55%], P=.015). There were no significant differences in perioperative complications between the groups. CONCLUSION: When using electrocautery, bilateral salpingectomy can be completed in the immediate postpartum period after vaginal delivery with equivalent operative times to bilateral tubal ligation.

A Standardized Protocol for Post-Partum Salpingectomy with Suture Ligation: A Prospective Feasibility Study

“…A recent metaanalysis evaluating salpingectomy at the time of cesarean demonstrated similar operative times across three randomized controlled trials comparing salpingectomy to bilateral tubal ligation without significant differences in perioperative complications, length of stay, EBL, or post-partum re-admissions [26]. Additionally, two other studies retrospectively evaluated operative outcomes for the incorporation of salpingectomy in the immediate post-partum period following vaginal delivery [21,22]. Danis et al [22] compared postpartum salpingectomy to post-partum bilateral tubal ligation in a retrospective consecutive cohort, and found significantly longer operative times for those undergoing post-partum salpingectomy (71.44 min ± 5.81 vs. 59.13 min ± 16 min p = 0.003) similar to our own findings.…”

“…Danis et al [22] compared postpartum salpingectomy to post-partum bilateral tubal ligation in a retrospective consecutive cohort, and found significantly longer operative times for those undergoing post-partum salpingectomy (71.44 min ± 5.81 vs. 59.13 min ± 16 min p = 0.003) similar to our own findings. Wagar et al [21] reported a shorter median operative time for post-partum salpingectomy compared to bilateral tubal ligation immediately following vaginal delivery (30)(31)(32)(33)(34)(35)(36)(37)(38) vs. 34 min [IQR 26-42], p = 032). However, 97% of post-partum salpingectomy cases utilized a bipolar electrocautery device [21].…”

“…Peri-operative complications, including wound dehiscence, wound infection, intra-operative injury, and need for blood transfusion, were also collected. The reported complication rates following post-partum tubal permanent contraception procedures, including tubal ligation and salpingectomy, are low and range from 0.3-2% [18,19,21], making an adequately powered study to detect meaningful differences in the complication rates between the two procedures unfeasible, especially because, at the time this study was performed, the complication rate of post-partum salpingectomy by this suture-based method was not known. Therefore, operative time was chosen as the primary outcome and EBL as the secondary outcome.…”

“…National professional organizations in the United States [8][9][10], Canada [11], and regional health authorities encourage salpingectomy at the time of benign gynecologic surgery for those with an average background risk, because it may achieve risk reduction while preserving ovarian function [8][9][10][11][12][13][14][15][16][17]. Salpingectomy at the time of benign gynecologic surgery as well as during cesarean and following vaginal delivery is safe, feasible, and cost effective [18][19][20][21][22][23].…”

“…Data promoting the safety of post-partum salpingectomy derive from studies utilizing costly electrocautery devices, which may only be available in high-resource settings [21]. Prospective evidence evaluating the safety of post-partum salpingectomy (PPS), particularly in low-resource settings or without using costly equipment, is still lacking.…”