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Contemporary Issues in Women's Health

Recent studies have indicated that the pathogenesis of ovarian cancer may originate in the fallopian tubes.1,2 Retrospective and observational registerbased studies from Scandinavia have found a lower incidence of ovarian cancer in women who have had a salpingectomy compared with women who have not undergone surgery.3,4 As a result, there has been an increase in bilateral salpingectomy at the time of hysterectomy. Moreover, a number of international societies have proposed this procedure as a useful preventative measure. However, there is insufficient scientific evidence that attests to the effectiveness and safety of adopting this method, and the question remains as to whether there is any downside to this strategy. For women requesting a permanent method of contraception at the time of caesarean section, or remote from pregnancy when done by laparoscopy, some clinicians have also started to perform bilateral salpingectomy rather than the traditional tubal ligation techniques. A Swedish group recently published a retrospective observational cohort study using data from the National Quality Register of Gynecological Surgery in Sweden.5 The principal objective was to assess the likelihood of surgical complications and menopausal symptoms when performing bilateral salpingectomy as well as benign hysterectomy. In addition, they studied: operative time; surgical complications; length of hospital stay; return time to healthy living after discharge; and number of missed workdays for hysterectomy with bilateral salpingectomy compared with hysterectomy alone. A secondary aim was to study the utilization of opportunistic salpingectomy in Sweden. From 2013, there was a rapid increase in the frequency of bilateral salpingectomy carried out at the time of benign hysterectomy: 1.9% in 2012; 8.9% in 2013; and 37.8% in 2016. Therefore, they focused their analysis on the period from 2013 to 2016, with analysis on almost 5000 women who had a hysterectomy either abdominally or laparoscopically. They noted a heightened risk of menopausal symptoms (adjusted relative risk, 1.33; 95% CI 1.04–1.69) 1 year after hysterectomy with bilateral salpingectomy compared with hysterectomy only. In women having salpingectomy, hospital occupancy was extended by 0.1 days and bleeding was noted to have marginally decreased in the salpingectomy group. Other outcome measures were not notably related with salpingectomy, although a slight correlation with increased possibility of minor complications was observed (adjusted relative risk, 1.30; 95% CI 0.93–1.83). The authors concluded that bilateral salpingectomy at the time of hysterectomy was associated with an increased risk of menopausal symptoms 1 year after surgery. They have recommended further research by randomized clinical trials in order to reduce the probability of surplus and indeterminable variables. They have also suggested longer followup procedures in order to accurately advise female patients on the dangers and advantages of opportunistic salpingectomy. This work also raises the issue of whether salpingectomy should be carried out as a measure for permanent contraception. As a result of these findings, clinicians should exercise caution until further research has been completed.