Success and Complications of Salpingectomy at the Time of Vaginal Hysterectomy

Robert, Magali; Cenaiko, D; Sepandj, Jasmine; S, Iwanicki

doi:10.1016/j.jmig.2015.04.012

Cited by 50 publications

(19 citation statements)

References 24 publications

(33 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Although this Canadian study was limited by a retrospective design, it showed increasing age and pelvic adhesions were risk factors with unsuccessful removal. 19 Our study showed that prior adnexal surgery and fibroids as an indication for surgery were associated with unsuccessful completion of planned vaginal salpingectomy. Prior adnexal surgery may predispose to tubal adhesions to the ovaries or surrounding structures that may increase difficulty of access to the fallopian tubes for removal.…”

Section: Commentmentioning

confidence: 65%

Feasibility of prophylactic salpingectomy during vaginal hysterectomy

Antosh

High

Brown

et al. 2017

American Journal of Obstetrics and Gynecology

View full text Add to dashboard Cite

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...

show abstract

Section: Commentmentioning

confidence: 65%

Feasibility of prophylactic salpingectomy during vaginal hysterectomy

Antosh

High

Brown

et al. 2017

American Journal of Obstetrics and Gynecology

View full text Add to dashboard Cite

show abstract

“…Two of the included studies were RCTs, seven were cohort studies, one was a case–control study, and one was a case series . Seven of the studies were prospective, and were conducted between 2001 and 2014. Four studies were retrospective register studies where data were collected between 1973 and 2011 .…”

Section: Resultsmentioning

confidence: 99%

“…In all studies the reason for hysterectomy was a benign cause, but the explicit causes were generally not reported. In the majority of the studies the salpingectomies were opportunistic . In the two retrospective register studies that evaluated the risk of EOC, the salpingectomy was for pathology in the fallopian tubes (indicated salpingectomy) and not concomitant with a hysterectomy .…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Efficacy of salpingectomy at hysterectomy to reduce the risk of epithelial ovarian cancer: a systematic review

Darelius

Lycke

Kindblom

et al. 2017

BJOG

View full text Add to dashboard Cite

show abstract

“…Although the evidence is limited, it seems that opportunistic salpingectomy may reduce the prevalence of ovarian cancer; hence, it should be performed during surgery for benign pelvic or genital conditions, and also in women who do not expect to have further children, instead of just tubal ligation. Prophylactic salpingectomy during laparoscopic, laparotomic or vaginal hysterectomy does not increase morbidity or severity of menopausal symptoms [17][18][19] . There is a need for prospective studies aimed at evaluating opportunistic bilateral salpingectomy in women without BRCA mutations, in order to obtain more evidence in this regard.…”

mentioning

confidence: 99%