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Feasibility of prophylactic salpingectomy during vaginal hysterectomy
Feasibility of prophylactic salpingectomy during vaginal hysterectomy
- Source :
- American journal of obstetrics and gynecology. 217(5)
- Publication Year :
- 2016
-
Abstract
- 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 χ 2 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/m 2 ; 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 Conclusion Vaginal salpingectomy is feasible in the majority of women undergoing vaginal hysterectomy and increases operating time by 11 minutes and blood loss by 6 mL. Women with prior adnexal surgery or uterine fibroids should be counseled about the possibility that removal may not be feasible.
- Subjects :
- Adult
medicine.medical_specialty
Uterine fibroids
medicine.medical_treatment
Operative Time
Blood Loss, Surgical
Bilateral Salpingectomy
03 medical and health sciences
Salpingectomy
0302 clinical medicine
Postoperative Complications
Uterine Prolapse
medicine
Hysterectomy, Vaginal
Humans
Prospective Studies
Menorrhagia
Ovarian Neoplasms
030219 obstetrics & reproductive medicine
Hysterectomy
Leiomyoma
business.industry
Obstetrics
Obstetrics and Gynecology
Uterine prolapse
Oophorectomy
Prophylactic Surgical Procedures
Middle Aged
medicine.disease
Surgery
medicine.anatomical_structure
030220 oncology & carcinogenesis
Uterine Neoplasms
Feasibility Studies
Median body
Female
business
Fallopian tube
Subjects
Details
- ISSN :
- 10976868
- Volume :
- 217
- Issue :
- 5
- Database :
- OpenAIRE
- Journal :
- American journal of obstetrics and gynecology
- Accession number :
- edsair.doi.dedup.....6418d028d74e6a84c5fa1dd99482f5b6