A comparative study of the technical feasibility of complete salpingectomy versus tubal ligation as a method of tubal sterilisation during caesarean delivery

Background: Recent theory on ovarian malignancy suggests its origin from primary foci in fallopian tubes. Prophylactic salpingectomy may benefit in risk reduction of ovarian cancer. The aim of the study was to compare the feasibility of complete salpingectomy with bilateral tubal ligation was made during caesarean delivery in women desirous of permanent sterilisation.Methods: We conducted a prospective interventional randomized control study in department of obstetrics and gynaecology, ESI-PGIMSR Basaidarapur, New Delhi from October 2018 to February 2021. 70 women participated in this study desiring permanent sterilisation during caesarean delivery. Patients were randomized into two groups who either underwent bilateral tubal ligation [group A (N=35)] or complete bilateral salpingectomy [group B (N=35)].Results: Procedure was completed in 91% patients in group A and 77% in group B (p >0.05) making both the procedures feasible. Total operative time (min) in group A and B were 47 and 55 respectively (p<0.01). Mean sterilisation procedure time (min) in group A was 5 and group B was 6 (p=0.13). No significant difference was seen in intra-operative blood loss (400 ml in group A vs 300 ml in group B), percentage decrease in post-op haemoglobin (g/dl) (4.56±2.96 in group A vs 3.91±2.7 in group B), post-operative serum Anti-mullerian hormone (AMH) levels (ng/ml) (group A-0.965±0.12 vs 0.7±0.09 in group B) in the two groups.Conclusions: Salpingectomy as an alternative to tubal ligation should be discussed with suitable patients desirous of permanent sterilisation during caesarean delivery.

Opportunistic Salpingectomy Versus Traditional Partial Salpingectomy at the Time of Cesarean Delivery: A Randomized Controlled Trial

BACKGROUND: It is estimated that one third of women in the United States opt for permanent tubal sterilization at the time of cesarean delivery. Evidence suggests that ovarian cancer begins in the fallopian tubes. Ovarian cancer has the highest mortality of all gynecologic malignancies. There is no proven effective screening for ovarian cancer. In view of this, the Royal College of Obstetricians & Gynecologists and the American College of Obstetricians and Gynecologists recommend considering counseling patients about prophylactic salpingectomy as an effective method of sterilization. There are limited well designed clinical trials that compare the safety and feasibility of total salpingectomy to that of traditional partial salpingectomy for tubal sterilization at the time of cesarean delivery. METHODS: We conducted a non-inferiority randomized controlled trial at the Mayo Clinic, Rochester, Minnesota. Women age 21 years and older who were undergoing cesarean delivery and desired concomitant sterilization were enrolled between May 17, 2017 and July 16, 2018. Stratified randomization was performed based on number of previous cesarean deliveries and their Basal Metabolic Index, into a bilateral total salpingectomy group and bilateral partial salpingectomy group. All salpingectomies were performed using clamps and suture. The primary outcome was to compare the mean peri-operative hemoglobin change for both groups. Secondary objectives included sterilization completion time, postoperative length of stay, estimated blood loss, postoperative pain and adverse events. RESULTS: Of the 111 women screened, 40 were enrolled and randomized. Of these, 38 underwent the assigned procedure (18 BTS, 20 BPS). There were no demographic differences between groups. No difference in Mean ±SD hemoglobin drop between groups (1.4±0.7 g/dl for the BTS group and 1.8±1.0 g/dl for the BPS group, p=0.08). Mean time to completion of sterilization procedure was significantly longer in the BTS group (16.3±5.6 minutes for the BTS group vs 5.1±1.6 minutes for the BPS group, p < .01). No significant differences for other outcome measures.CONCLUSIONS: Bilateral total salpingectomy at the time of cesarean delivery does not increase the risk for blood loss and has similar peri-operative outcomes, with a small increase in operative time when compared to traditional bilateral partial salpingectomy. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03135431, 27/04/2017

Feasibility of Prophylactic Bilateral Salphingectomy during Vaginal Hysterectomy- A Prospective Longitudinal Cohort Study

Introduction: Fallopian tubes are not commonly removed during vaginal hysterectomy because of inadequate surgical training or fear of increased morbidity. Aim: The primary objective of this study was to estimate the proportion of planned bilateral salpingectomies successfully completed vaginally. Materials and Methods: This was a prospective, interventional longitudinal cohort study conducted in the Department of Obstetrics and Gynaecology at ESI, PGIMSR, Basaidarapur, New Delhi. From December 2018 to November 2019, all women undergoing vaginal hysterectomy for benign conditions were offered prophylactic salpingectomy. Operative time, blood loss and reason for non completion for salpingectomy were recorded. Patients were followed-up for six weeks. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) 17.0. Continuous variables were described with mean and the categorical variables were described with frequencies and percentages. Results: Thirty-five patients were enrolled in the study. The most common indications for vaginal hysterectomy for benign conditions included uterovaginal prolapse in 21 (60%) patients and adenomyosis and fibroids in 10 (30%) and 4 (10%) patients respectively. Of the 35 patients, vaginal salpingectomy was successful in 31 (88.5%) patients. Factors which led to non completion of salpingectomy were pelvic adhesions and atrophic ovaries in 2 (5.7%) patients each. Mean operating time for bilateral vaginal salpingectomy was 14.05±2.75 minutes. Mean Estimated Blood Loss (EBL) for bilateral salpingectomy was 19.86±6.88 mL. Conclusion: Bilateral prophylactic salpingectomy with vaginal hysterectomy for benign conditions is feasible in most of the patients. Routine salpingectomy should be offered to women undergoing vaginal hysterectomy for benign conditions to prevent risk of ovarian carcinoma in future.