Safety outcomes of female sterilization by salpingectomy and tubal occlusion

Abstract

TitleAbstract Objective: Compare immediate and short-term complications and surgical times among women having laparoscopic salpingectomy or tubal occlusion for female sterilization. Study design: We used billing data to identify women having laparoscopic sterilization at our training institution between July 1, 2011, and June 30, 2015. We performed a retrospective chart review to extract demographic information, surgical times and complications within 30 days, including unscheduled clinic or emergency room visits. We categorized complications as immediate (prior to discharge) and short-term (within 30 days after the procedure). Surgeries including additional procedures other than IUD removal were considered mixed operations. Mixed operations and unilateral sterilization procedures were only included in safety evaluations. Results: The 149 procedures included 81 salpingectomies (including 18 mixed operations and 2 unilateral salpingectomies) and 68 tubal occlusions (including 8 mixed operations). All procedures involved Obstetrics and Gynecology residents. Salpingectomy and occlusion procedures had similar immediate (2.5% vs. 2.9%, p=1.0) and short-term (4.9% vs. 14.7%, p=.051) complication rates. Surgical time averaged 6 min longer for salpingectomies than occlusion procedures (44 vs. 38 min, respectively, p=.018). Average surgical times were shorter with more experienced (3rd/4th year) residents than less experienced (1st/2nd year) residents for both salpingectomy (32±18 min vs. 46±13 min, respectively, p=.124) and occlusion procedures (32±13 min vs. 41±12 min, respectively, p=.026). Conclusion: Salpingectomy for female sterilization takes slightly longer to complete than tubal occlusion procedures without evidence that it increases complications. Implications statement: Laparoscopic salpingectomy is a safe alternative to tubal occlusion with only a small increase in surgical time. Because salpingectomy offers higher efficacy and more ovarian cancer protection than occlusion procedures, salpingectomy should be an option offered to women seeking laparoscopic sterilization.

Comparing options for females seeking permanent contraception in high resource countries: a systematic review

“…The characteristics and results of all included studies can be found in Table 1 . Six studies compared effectiveness [ 34 – 39 ]; 15 assessed adverse effects [ 17 , 18 , 34 , 35 , 38 – 48 ]; three compared patient recovery [ 18 , 35 , 44 ]; five compared non-contraceptive benefits, primarily the reduction of cancer risk [ 43 , 49 – 52 ]; six compared tolerability [ 34 , 35 , 37 – 39 , 52 ]; four compared costs to the healthcare system; [ 38 , 53 – 55 ] and seven compared length of procedures [ 17 , 18 , 38 , 44 , 47 , 48 , 55 ]. No included studies compared accessibility, eligibility, or follow-up required.…”

“…Fifteen studies assessed adverse effects. Results are organized by comparison: six compared hysteroscopic tubal occlusion and laparoscopic tubal ligation [ 34 , 35 , 38 – 41 ], two compared laparoscopic tubal ligation and a control [ 42 , 43 ], five compared laparoscopic tubal ligation and bilateral salpingectomy [ 17 , 18 , 44 , 45 , 48 ], one compared hysteroscopic tubal occlusion, laparoscopic tubal ligation, and bilateral salpingectomy with controls [ 46 ], and one compared bilateral salpingectomy with laparoscopic tubal ligation and with historical matched controls [ 47 ].…”

“…Three studies found that there was no significant difference when comparing risk of readmission, blood transfusion, or intraoperative complications between laparoscopic tubal ligation and bilateral salpingectomy [ 17 , 18 , 44 ], nor any difference in post-procedure physician visits for surgical infection or complication [ 45 ]. No significant differences in complications were found when assessing both immediate (2.9% vs. 2.5%, p = 1.0) and short-term (within 30 days) adverse events (14.7% vs. 4.9%, p = 0.51) among people undergoing laparoscopic tubal ligation and bilateral salpingectomy, respectively [ 48 ]. However, there was a higher risk among people who underwent bilateral salpingectomy who required prescription analgesic use after surgery compared to those who underwent laparoscopic tubal ligation [(aOR 1.21 (1.14–1.29)] [ 45 ].…”

“…Four studies found that the bilateral salpingectomy procedure took significantly longer than laparoscopic tubal ligation to complete (3–11 min longer) [ 17 , 18 , 44 , 48 ] Median/mean surgical times ranged between 33 [ 18 ] and 44 [ 48 ] min for bilateral salpingectomy, and between 30 [ 18 ] and 38 [ 48 ] min for laparoscopic tubal ligation. Overall median operative times were similar between bilateral salpingectomy and tubal ligation (study and historical controls) [ 47 ].…”

Women's preferences for permanent contraception method and willingness to be randomized for a hypothetical trial

“…Female tubal occlusive permanent contraception procedures are estimated to reduce a woman’s lifetime risk of ovarian cancer by 24% to 34% [5,6]; however, women undergoing salpingectomy have a 64% risk reduction for serous epithelial ovarian and primary peritoneal carcinoma compared with women who have tubal occlusion or no permanent contraception procedure [7]. Furthermore, recent studies have shown no increased surgical risks with salpingectomy compared to occlusive procedures during laparoscopy, except for a minimal increase in operative time [8,9], or during cesarean delivery [10]. Use of salpingectomy for permanent contraception is increasing during laparoscopic sterilization and cesarean delivery [11,12] and ACOG has acknowledged salpingectomy as an effective method of contraception that may provide ovarian cancer risk reduction [13].…”