AT SGS 2017
SAN ANTONIO (FRONTLINE MEDICAL NEWS) – Surgeons at Houston Methodist Hospital reported a 75% success rate in removing both fallopian tubes during vaginal hysterectomy in a study presented at the annual scientific meeting of the Society of Gynecologic Surgeons.
Serous ovarian carcinoma is now thought to arise from the distal fallopian tube, and it’s estimated that salpingectomy prevents diagnosis of ovarian cancer in 1 in 225 women and death from ovarian cancer in 1 in 450 women. The American Congress of Obstetricians and Gynecologists recommends that surgeons and patients “discuss the potential benefits of the removal of the fallopian tubes” during hysterectomy in women not having an oophorectomy.
The advice has led to an increase in salpingectomies during laparoscopic and open hysterectomies, but removal is uncommon in vaginal hysterectomy, perhaps because of the perceived difficulty of removing the fallopian tubes vaginally.
The findings from the Houston team show that “it’s feasible in most cases, with very little risk,” said Danielle Antosh, MD , lead investigator and director of the Center for Restorative Pelvic Medicine at Houston Methodist Urogynecology Associates.
“People are doing laparoscopic hysterectomies or robotic hysterectomies” to get at the fallopian tubes, “but they shouldn’t be deterred from trying to remove the fallopian tubes vaginally,” Dr. Antosh said at the SGS 2017 meeting, which was jointly sponsored by the American College of Surgeons. When women are having a vaginal hysterectomy, “why not try to remove the fallopian tubes? It’s something I would definitely consider counseling your patients about.”
Dr. Antosh said that residents should be taught how to perform salpingectomy during vaginal hysterectomy. “I think it is definitely feasible for residents to do.” Technically, “it’s a lot easier than removing the ovaries” vaginally, she said.
The 70 women in the study were undergoing vaginal hysterectomies by attending physicians for benign reasons, mostly uterine prolapse, followed by heavy menstrual flow and fibroids. In total, 52 (75%) had successful concomitant bilateral vaginal salpingectomies, and 7 additional women had one tube removed. Success was more likely with increasing parity and a history of prolapse. Most of the failures were because the tubes were too high in the pelvis or there were adhesions from prior adnexal surgery. Even with prior adnexal surgery, however, the success rate was 50%.
Vaginal salpingectomy added a mean of 11 minutes to surgery and a mean of 5 mL blood loss. There were no complications reported from including salpingectomy with vaginal hysterectomy. The study wasn’t powered to detect an impact on menopause symptoms, but there was a decrease in menopause symptoms at 16 week follow-up in the salpingectomy group, perhaps related to less sexual dysfunction and urinary incontinence.
The mean age in the study was 51 years, and mean body mass index was 27 kg/m2. There were no malignancies found on tubal pathology.
Five women were transferred to an abdominal approach because of a large uterus or discovery of ovarian pathology. None were transferred for the purpose of salpingectomy.
There was no external funding for the study, and the investigators reported no relevant financial disclosures.