A Standardized Protocol for Post-Partum Salpingectomy with Suture Ligation: A Prospective Feasibility Study

Abstract

Our objective is to define a standard protocol for post-partum salpingectomy and provide a prospective assessment of safety and feasibility of such a procedure. Thus, a protocol for performing post-partum salpingectomy in limited-resource environments was created based on contemporary practices for tubal ligation. Gravidae presenting for post-partum tubal ligation following vaginal delivery or at time of cesarean were prospectively approached and, if consent was obtained, enrolled. Outcomes were compared to a historical cohort of gravidae who underwent standard post-partum tubal ligation following vaginal birth or at the time of cesarean as per institutional standard of care. The primary outcome was operative time. One hundred and fifty-seven subjects underwent post-partum salpingectomy following cesarean or vaginal delivery (on post-partum days 0–2). Post-partum salpingectomy performed after vaginal delivery (n = 97) resulted in slightly longer operative times (39.1 ± 11.8 vs. 34.3 ± 13.1 min, p = 0.003) and slightly greater blood loss (21.0 ± 22.0 vs. 13.4 ± 17.3 mL, p = 0.001) than modified Pomeroy tubal ligation (n = 200). Post-partum salpingectomy at cesarean resulted in no difference in estimated blood loss, but slightly longer operative times compared to Parkland tubal ligations (99.5 ± 47.3 vs. 86.5 ± 33.9 min, p = 0.048). Surgical complications for post-partum salpingectomy were similar to controls, regardless of when the procedure was performed. In conclusion, a standardized protocol created for post-partum salpingectomy using suture ligation is feasible and safe.

Postpartum Opportunistic Salpingectomy Compared With Bilateral Tubal Ligation After Vaginal Delivery for Ovarian Cancer Risk Reduction

“…Several studies have reported procedural risks of opportunistic salpingectomy immediately after vaginal delivery. 11,16,18,23 Opportunistic salpingectomy requires similar operative time, results in similar blood loss, and has similar rates of short-term postoperative complications compared with bilateral tubal ligation. 11,16,18 When energy devices are used, salpingectomy can be completed in shorter operative times relative to traditional methods of suture ligation, with improved surgeon satisfaction.…”

“…7 After these endorsements, this procedure was widely implemented into routine practice. [11][12][13][14] Opportunistic salpingectomy has been repeatedly demonstrated to be a safe alternative to a variety of standard tubal ligation methods across various surgical settings, including at the time of benign gynecologic surgery, during cesarean delivery, and in the immediate postpartum period, with similar surgical, reproductive, and hormonal outcomes. [14][15][16][17][18] Thus, the use of tubal ligation at vaginal delivery is decreasing in recent years in the United States.…”

“…11,16,18,23 Opportunistic salpingectomy requires similar operative time, results in similar blood loss, and has similar rates of short-term postoperative complications compared with bilateral tubal ligation. 11,16,18 When energy devices are used, salpingectomy can be completed in shorter operative times relative to traditional methods of suture ligation, with improved surgeon satisfaction. 16,23 Venkatesh et al 24 recently reported results of a cost-effectiveness model evaluating opportunistic salpingectomy compared with tubal ligation at the time of cesarean delivery over a wide range of cancer risk reduction and perioperative complication probabilities.…”