Women whose fallopian tubes are removed during sterilization via laparoscopy may have only marginally more surgical complications compared with those whose tubes are cut during tubal occlusion, according to a recent study published by Strandell et al in The Lancet Regional Health–Europe. The findings showed that the procedure may be safe and can help protect against ovarian cancer.
Background
Ovarian cancer is a relatively rare yet serious disease with a gradual progression that lacks early symptoms. Because ovarian cancer is frequently detected late, the prognosis is often poor. According to the World Health Organization, around 440,000 women are diagnosed with ovarian cancer each year globally.
In more than 50% of cases, ovarian cancer appears to start in the fallopian tubes before spreading to the ovaries. Women who undergo sterilization can be offered fallopian tube removal—known as opportunistic salpingectomy. This procedure is established practice in gynecologic surgery for pathologic changes.
Complications during tubal surgery can include bleeding during surgery, prolonged pain, urinary tract infections, wound infections, and hernias.
However, until recently, it has not been known whether salpingectomy may entail more surgical complications, which may discourage many women from undergoing the procedure.
Study Methods and Results
In the recent study, researchers randomly assigned 972 women who were to be sterilized via laparoscopy to undergo either extended surgery with salpingectomy (n = 473) or standard sterilization with tubal occlusion (n = 499).
Compared with those in the tubal occlusion group, the researchers found that 8.1% vs 6.2% of the women in the salpingectomy group experienced a complication within 8 weeks of the procedure. They classified the rate as an accepted difference without clinical significance.
The researchers reported that the time taken for the procedure differed. The average time was 45 minutes during salpingectomy vs 29 minutes during tubal occlusion.
Conclusions
“Every case of ovarian cancer we can avoid is a big win for society and for those women who would otherwise have been affected,” highlighted lead study author Annika Strandell, MD, PhD, Associate Professor at the Sahlgrenska Academy at the University of Gothenburg and a consultant gynecologist at the Sahlgrenska University Hospital. “Surgery to remove fallopian tubes during sterilization could provide an opportunity to prevent many new cases of cancer,” she underscored.
The researchers are currently investigating hormonal effects in women whose fallopian tubes have been removed during sterilization, including whether menopause occurs earlier with a risk of adverse health effects. This aspect of their research requires a longer follow-up period, and the first results are expected within a few years.
Disclosure: For full disclosures of the study authors, visit thelancet.com.
