Opportunistic salpingectomy: uptake, risks, and complications of a regional initiative for ovarian cancer prevention

McAlpine, Jessica N.; Hanley, Gillian E.; Woo, Michelle; Tone, Alicia A.; Rozenberg, Nirit; Swenerton, Kenneth D.; Gilks, C Blake; Finlayson, Sarah; Huntsman, David G.; Miller, Dianne

doi:10.1016/j.ajog.2014.01.003

Cited by 262 publications

(245 citation statements)

References 29 publications

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“…Our study corroborates the findings of McAlpine and colleagues [9] from British Columbia and shows that their findings are generalizable. Limitations of our study include the limits of retrospective data collection and that women may have gone to other healthcare providers with complications.…”

Section: Discussionsupporting

confidence: 83%

“…The immediate complications (one in each group) resulted from anesthetic issues. Surgical times were slightly longer for salpingectomy than for tubal occlusion methods, supporting the findings of McAlpine and colleagues [9]. We expected before performing our analysis that salpingectomy would take slightly longer to complete than tubal occlusion and that this difference would decrease with advancing surgical experience.…”

Section: Discussionsupporting

confidence: 76%

“…Despite a large study from British Columbia, Canada showing no increased risks for salpingectomy compared to occlusive procedures, salpingectomy has still not been widely adopted as a primary method of sterilization [9]. The only difference in outcome between salpingectomy and occlusion appears to be 10 min in operating time.…”

Section: Introductionmentioning

confidence: 99%

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Safety outcomes of female sterilization by salpingectomy and tubal occlusion

Westberg

Scott²,

Creinin³

2015

Contraception

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TitleAbstract Objective: Compare immediate and short-term complications and surgical times among women having laparoscopic salpingectomy or tubal occlusion for female sterilization. Study design: We used billing data to identify women having laparoscopic sterilization at our training institution between July 1, 2011, and June 30, 2015. We performed a retrospective chart review to extract demographic information, surgical times and complications within 30 days, including unscheduled clinic or emergency room visits. We categorized complications as immediate (prior to discharge) and short-term (within 30 days after the procedure). Surgeries including additional procedures other than IUD removal were considered mixed operations. Mixed operations and unilateral sterilization procedures were only included in safety evaluations. Results: The 149 procedures included 81 salpingectomies (including 18 mixed operations and 2 unilateral salpingectomies) and 68 tubal occlusions (including 8 mixed operations). All procedures involved Obstetrics and Gynecology residents. Salpingectomy and occlusion procedures had similar immediate (2.5% vs. 2.9%, p=1.0) and short-term (4.9% vs. 14.7%, p=.051) complication rates. Surgical time averaged 6 min longer for salpingectomies than occlusion procedures (44 vs. 38 min, respectively, p=.018). Average surgical times were shorter with more experienced (3rd/4th year) residents than less experienced (1st/2nd year) residents for both salpingectomy (32±18 min vs. 46±13 min, respectively, p=.124) and occlusion procedures (32±13 min vs. 41±12 min, respectively, p=.026). Conclusion: Salpingectomy for female sterilization takes slightly longer to complete than tubal occlusion procedures without evidence that it increases complications. Implications statement: Laparoscopic salpingectomy is a safe alternative to tubal occlusion with only a small increase in surgical time. Because salpingectomy offers higher efficacy and more ovarian cancer protection than occlusion procedures, salpingectomy should be an option offered to women seeking laparoscopic sterilization.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionsupporting

confidence: 76%

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Safety outcomes of female sterilization by salpingectomy and tubal occlusion

Westberg

Scott²,

Creinin³

2015

Contraception

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“…Although it has been well-documented that the vaginal or laparoscopic approaches are connected with less postoperative pain and fewer complications, more rapid recovery in a hospital, less blood loss, and less cost, approximately 60% of the procedures continue to be performed abdominally. Variations in the surgical techniques have been introduced to reduce operative morbidity and postoperative effects of hysterectomy on the urinary and sexual functions [8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Hysterectomy trends for benign indications over a 15-year period in an academic teaching center in Poland: a retrospective cohort study

Romanek-Piva

Gałczyński²,

Adamiak‐Godlewska³

et al. 2016

Ginekol Pol

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Objectives: The aim of the study was to evaluate changes in the operative trends for various types of hysterectomy due to benign indications, between 2001 and 2015, at the 2 nd Department of Gynecology, Medical University of Lublin, as compared to the National Health Service (NHS) registry in Poland. Material and methods:A retrospective cohort study was conducted. Data from the Internal Hospital Discharge Registry and Pathological Results Registry have been compared to the NHS database, which has been available nationwide since 2009. Results:The study group included 5629 women who underwent hysterectomy due to benign indications. During the study period, the following number of procedures were performed: total abdominal hysterectomy -344 (6.11%), total abdominal hysterectomy with bilateral salpingo-oophorectomy -1760 (31.27%), total vaginal hysterectomy -563 (10.00%), subtotal abdominal hysterectomy -2536 (45.05%), and laparoscopically-assisted subtotal hysterectomy (LASH) -426 (7.57%). The abdominal route, with the preference for subtotal abdominal hysterectomy, was the main approach to hysterectomy. Symptomatic fibroids were the most common indication for the procedure. Comparison of data collected over the last five years revealed a significant difference in the approach to hysterectomy in favor of subtotal abdominal hysterectomy (SAH) and LASH.Conclusions: Less invasive techniques of hysterectomy (LASH, SAH), which are the preferred choice at the 2 nd Department of Gynecology (Lublin), are safe and effective options of treating benign conditions. We are of the opinion that these approaches should be offered to patients instead of more radical techniques. Proper training of physicians may influence the decision-making process in favor of minimally invasive techniques.

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“…The most important evidence of changes in surgical practices is provided by OVCARE, members of which recently [15] demonstrated that their 2010 educational initiative was followed by a shift in surgical paradigm in their province that involved increases in the utilization of hysterectomy with PBS (5%-35%, p , .001) and PBS for sterilization (0.5%-33%, p , .001) over the study period.…”

mentioning

confidence: 99%

The Fallopian Tube in the 21st Century: When, Why, and How to Consider Removal

2015

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Both the American College of Obstetricians and Gynecologists (ACOG) and the American Cancer Society have recommended that surgeons should discuss the potential benefits of the prophylactic removal of the Fallopian tubes for permanent contraception or during surgeries for benign pathologies with every woman at risk for ovarian cancer. With the release of the ACOG Committee on Gynecologic Practice, the time has finally come to extend this information from specialist colleges to the entire medical community.

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Opportunistic salpingectomy: uptake, risks, and complications of a regional initiative for ovarian cancer prevention

Cited by 262 publications

References 29 publications

Safety outcomes of female sterilization by salpingectomy and tubal occlusion

Safety outcomes of female sterilization by salpingectomy and tubal occlusion

Hysterectomy trends for benign indications over a 15-year period in an academic teaching center in Poland: a retrospective cohort study

The Fallopian Tube in the 21st Century: When, Why, and How to Consider Removal

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