Grand Rounds

Should Fallopian Tubes Also Be Removed During Ovarian Conserving Benign Hysterectomy?

BACKGROUND AND PURPOSE:

Evidence exists that high-grade serous ovarian carcinoma may begin in the distal fallopian tube in the majority of cases
ACOG and SGO have recommended that bilateral salpingectomy be considered and discussed with patients at the time of ovarian conserving benign hysterectomy
Till et al. (JMIG, 2017) aimed to:
- Determine if there has been change in practice regarding opportunistic salpingectomy
- Examine patient, operative and hospital related factors
- Evaluate complications that may be associated with salpingectomy

Retrospective cross-sectional study of women undergoing ovarian conserving benign hysterectomy
Primary outcomes were performance of opportunistic salpingectomy with ovarian preservation
Rate of salpingectomy was examined at four-month intervals to study changes over time
Independent effects of patient co-morbidities and operative/hospital factors were evaluated

21,978 women undergoing hysterectomy were obtained from the database
- 10,676 ovarian conserving benign surgeries were analyzed
Salpingectomy rate was 45.8% (n= 4,890)
Rates of opportunistic salpingectomy increased over the study period from 27.5% to 61.6% (p<0.001)
Salpingectomy was more likely with laparoscopic approach, nulliparity and age <60
Salpingectomy rate was variable between hospitals
Although salpingectomy increased operative time by 12 minutes, there was no increase in estimated blood loss or perioperative complications

Salpingectomy rate increased as the study progressed
Laparoscopic approach and younger ager are associated with increased probability of salpingectomy
Salpingectomy are not associated with perioperative complications or increased blood loss
Increasing the salpingectomy rate should be a quality improvement target, in keeping with ACOG guidance
Stuparich et al. (JMIG, 2017) have developed an educational video on how to perform salpingectomy during laparoscopic hysterectomy is publicly available (see ‘Learn More – Primary Sources’ below)

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