Learn when your doctor might recommend having your fallopian tubes removed and what to expect from the procedure
When you think of gynecologic surgery, the first procedure that comes to mind might be hysterectomy, or maybe tubal ligation, a.k.a.
“getting your tubes tied”
to prevent future pregnancies. But there’s a lesser-known procedure, called salpingectomy, that is increasingly being performed both for sterilization and for medical purposes including prevention of ovarian cancer. In fact, salpingectomy—or removal of the fallopian tubes, the tiny tunnels that eggs travel down to get from your ovaries to your uterus—is now the preferred method for permanent sterilization in women. Let’s take a look at why your doctor might recommend this procedure and what to expect if you have it.
Why Is Salpingectomy Performed?
According to research, the annual number of salpingectomies performed has increased 77% between 2000 and 2013 (from 15,512 to 27,530). And a German study found that salpingectomies quadrupled between 2005 and 2020.
A salpingectomy may be recommended for any of these reasons:
A blocked or damaged fallopian tube
Ectopic pregnancy, which is when a fertilized egg implants in the fallopian tube or somewhere else instead of the uterus
Endometriosis, a painful condition in which uterine tissue grows in other parts of the abdomen
Permanent prevention of pregnancy (also called sterilization)
Treatment or prevention of ovarian cancer or fallopian tube cancer
The most common reasons for having salpingectomy are sterilization, ectopic pregnancy, and benign or cancerous growths in the fallopian tube.
Salpingectomy for Ovarian Cancer Prevention
It might seem strange to prophylactically remove your fallopian tubes for the purposes of preventing cancer in the ovaries. However, most ovarian cancer doesn’t start in the ovary. It starts as tinier microscopic disease in the end of the fallopian tube.” Removing the fallopian tubes helps prevent those cancer cells from working their way up into the ovaries. Prevention is crucial for a cancer that has no screening test and only a 30% five-year relative survival rate once it has spread beyond the ovary. While the risk of ovarian cancer is about 2% in the general population, women who carry a mutation in the BRCA1 or BRCA2 gene have a greatly elevated risk: anywhere from 10% to 46%. It is suggested considering salpingectomy if you have a BRCA mutation and are between the ages of 35 and 40 or are done having children. If you’re at average risk for ovarian cancer, ACOG suggests asking your doctor about salpingectomy if you are finished having children and are considering permanent sterilization, or if you’re already having a gynecologic procedure like a hysterectomy (during which the surgeon can also do a salpingectomy).
Salpingectomy vs. Salpingectomy-Oophorectomy
While a salpingectomy removes one or both fallopian tubes but leaves the ovaries intact, salpingectomy-oophorectomy (also called salpingo-oophorectomy) takes out one or both fallopian tubes plus your ovaries. This combo surgery is done as a treatment for endometriosis, ovarian cysts, and other growths, as well as for ovarian torsion (in which an ovary gets twisted). It’s also done in some women at high risk of ovarian cancer. Once your ovaries come out, you’ll be in menopause, which carries its own health risks including cardiovascular disease and bone loss. For this reason, clinical trials are looking at the benefits of doing salpingectomy first in younger women at elevated risk of ovarian cancer while leaving the ovaries intact, in order to preserve hormone production and delay menopause-related problems. An oophorectomy is then done once the woman naturally reaches menopause.
Types of Salpingectomy
Salpingectomy can be either bilateral (the surgeon takes out both tubes) or unilateral (only one tube removed). How much of the fallopian tube your surgeon removes and the timing of the surgery will depend on your age, stage of life, health, and cancer risk. These are the main types of salpingectomy:
Partial Salpingectomy
As the name suggests, this procedure only removes part of the fallopian tubes. This is an option for people who are done having children but prefer not to remove their entire fallopian tubes. A partial salpingectomy won’t decrease ovarian cancer risk as much as removing both tubes.
Complete (Total) Salpingectomy
A total or complete salpingectomy removes all of one or both fallopian tubes. This is done for sterilization or to treat a health condition like endometriosis.
Salpingectomy With Ovarian Preservation
This procedure removes the fallopian tubes but leaves the ovaries in place. Generally, if you have salpingectomy for sterilization alone, you’ll keep your ovaries. This procedure is also done in some young women who are at elevated risk for ovarian cancer, with an oophorectomy to follow after menopause, as described above. Some centers, including Johns Hopkins, offer this option.
Opportunistic Salpingectomy
Opportunistic means the fallopian tubes are removed during another surgery—for example, if you’re having a C-section and you know you don’t want more children, or you’re having a hysterectomy.
How to Prepare for a Salpingectomy
You’ll meet with your surgeon beforehand to discuss how to prepare for the procedure. The type of preparation will depend on whether you’re having a standalone salpingectomy, a salpingectomy-oophorectomy, or a salpingectomy with another procedure (opportunistic salpingectomy).
To prepare for your salpingectomy, you might:
Have blood tests to make sure you’re healthy enough to undergo surgery.
Stop medications that can increase bleeding, like nonsteroidal anti-inflammatory drugs (NSAIDs), in the days and weeks leading up to your procedure.
If you smoke, quit. Ideally you should quit six to eight weeks before your procedure. Smoking can slow healing time after surgery.
Shower with a special cleansing solution called Hibiclens (chlorhexidine) before your surgery to lower the risk of infection.
Ask your surgeon and anesthesiologist what you need to do before your procedure.
What Happens During a Salpingectomy
Salpingectomy can be done in two ways: laparoscopically or through an open incision. Typically, it’s done laparoscopically for contraceptive sterilization. But if you’re having a C-section or other abdominal surgery, it will be done through the same open incision as the other procedure.
Laparoscopic Salpingectomy
The laparoscopic procedure is done through three small incisions in your belly while you are under general anesthesia. The surgeon inserts a thin scope with a light and camera on the end into one incision, and very small surgical instruments into the other openings. Your belly is inflated with gas to give the surgeon a clear view of your fallopian tubes. Once your surgeon has removed your fallopian tubes, they will close the incision and the gas will eventually leave your body through belching, flatulence, or while you poop. Usually, laparoscopic salpingectomy is done as an outpatient procedure. Women come into the hospital, have [the surgery] done, and they go home the same day.
Open Abdominal Salpingectomy
This procedure is done through an open incision, usually at the same time as a C-section, hysterectomy, or other abdominal surgery. How the surgery is performed depends on the other procedure you’re having.
Recovering from Salpingectomy
You should be fully recovered from laparoscopic salpingectomy in about two weeks. Recovery after open surgery can take longer, depending on which type of surgery you had. There aren’t many restrictions after laparoscopic surgery, except to avoid lifting anything heavier than 10 pounds and to not sit in warm bathtubs, hot tubs, or swimming pools for about six weeks. Other than that, there really is no significant limitation.
Potential Complications of Salpingectomy
The risk of complications from laparoscopic salpingectomy is low—about 2.5% right after surgery, according to a study on safety outcomes published.
Our experts say the most common risks from this procedure include:
Bleeding
Blood loss
Infection
Pain
Damage to surrounding organs like the uterus
You’ll have the lowest risk of complications in the hands of an experienced surgeon. You want someone who’s doing several of these cases a week, and preferably somebody who’s done hundreds, if not thousands of these procedures.
Pregnancy After Salpingectomy
Can you get pregnant without your fallopian tubes? Yes, but if you had both fallopian tubes removed, you’ll need to conceive via in vitro fertilization (IVF), which may be more difficult. That involves retrieving eggs from your ovaries and fertilizing them with sperm, then transferring the resulting embryo (or embryos) into your uterus. Before having your ovaries removed, you can undergo a process called oocyte (egg) retrieval. In oocyte retrieval, eggs are taken from your ovaries and either frozen or combined with your partner’s sperm to create an embryo, which is then frozen until you’re ready to conceive via IVF.
Any surgery is a big decision that you should make only after careful consideration of the risks and benefits. Meet with your obstetrician-gynecologist to talk about your family history, your risk of ovarian cancer, what your desires are in terms of birth control, whether you’re done having kids or not, and if you’re interested in considering contraceptive sterilization. Whether you’re thinking about salpingectomy for sterilization or to reduce your risk for ovarian cancer, you need to be sure that you’re done having children—or that you’d be OK with IVF being your only option for pregnancy. Unlike tubal ligation, this procedure isn’t reversible. You can’t really go back on this.
Adapted from: HC
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