Our Summary

This research paper discusses the growing evidence that the fallopian tubes are the starting point for most cases of serious ovarian or peritoneal cancers. As a result, some have suggested changing surgical practices for women at risk of ovarian cancer. One suggested change is to remove both fallopian tubes during a hysterectomy, a procedure called opportunistic salpingectomy (OS), instead of just tying the tubes. There’s been some talk of using this procedure for women with BRCA1/2 mutations to delay ovary removal, but there’s not enough evidence to say this is a safe alternative. It seems more doctors are performing OS during hysterectomies, but it’s less common to do so for sterilization. Adding OS to a hysterectomy or sterilization procedure doesn’t seem to increase the risk of complications or significantly extend surgery time. Early studies don’t show a negative impact on ovarian function, but we need long-term data to be sure. Some evidence suggests that removing the fallopian tubes could reduce ovarian cancer rates, but this needs more research. Early financial calculations suggest that OS could be a cost-effective cancer prevention strategy. While these early findings are promising, we need more research, especially long-term studies, to confirm the safety and effectiveness of this procedure.

FAQs

  1. What is opportunistic salpingectomy (OS) and how does it relate to preventing ovarian cancer?
  2. Is it safe for women with BRCA1/2 mutations to delay ovary removal by opting for opportunistic salpingectomy instead?
  3. Does adding opportunistic salpingectomy to a hysterectomy or sterilization procedure increase the risk of complications or extend surgery time?

Doctor’s Tip

A doctor might tell a patient considering bilateral tubal ligation that there is growing evidence suggesting that removing the fallopian tubes during the procedure could potentially reduce the risk of ovarian or peritoneal cancers. This procedure, known as opportunistic salpingectomy (OS), is being increasingly performed during hysterectomies but is less common for sterilization. While early studies do not show negative impacts on ovarian function, more research is needed to confirm the safety and effectiveness of this approach. Patients should discuss the option of including OS in their procedure with their healthcare provider to weigh the potential benefits and risks.

Suitable For

Patients who may be recommended bilateral tubal ligation include those at high risk for ovarian or peritoneal cancers, such as women with BRCA1/2 mutations. Additionally, women who are seeking permanent contraception may also be recommended this procedure. It is important for patients to discuss the potential risks and benefits of bilateral tubal ligation with their healthcare provider to determine if it is the right option for them.

Timeline

  • Before bilateral tubal ligation:
  1. Patient consults with their healthcare provider to discuss their desire for permanent contraception.
  2. Patient undergoes counseling to understand the risks and benefits of tubal ligation.
  3. Patient schedules the surgical procedure and prepares for it by following any pre-operative instructions provided by the healthcare provider.
  4. Patient undergoes the bilateral tubal ligation procedure, which involves blocking or sealing off the fallopian tubes to prevent pregnancy.
  • After bilateral tubal ligation:
  1. Patient may experience some pain and discomfort in the abdominal area immediately after the procedure.
  2. Patient is typically able to go home the same day or within a few days after the procedure, depending on the type of tubal ligation performed.
  3. Patient may experience some spotting or light bleeding for a few days after the procedure.
  4. Patient is advised to avoid heavy lifting and strenuous activities for a certain period of time to allow for proper healing.
  5. Patient may experience changes in their menstrual cycle or menstrual flow after the procedure, although this is usually temporary.
  6. Patient follows up with their healthcare provider for a post-operative appointment to ensure proper healing and to discuss any concerns or questions.
  7. Patient can expect to have permanent contraception and no longer have to worry about pregnancy.

What to Ask Your Doctor

  1. What is bilateral tubal ligation and how is it different from opportunistic salpingectomy (OS)?
  2. What are the potential risks and benefits of bilateral tubal ligation compared to OS?
  3. Are there any long-term studies or evidence supporting the use of bilateral tubal ligation for ovarian cancer prevention?
  4. What is the impact on ovarian function after bilateral tubal ligation?
  5. Is there a recommended age or risk factor profile for considering OS instead of traditional tubal ligation?
  6. How common is it for doctors to perform OS during sterilization procedures?
  7. What is the recovery time and potential complications associated with bilateral tubal ligation or OS?
  8. Are there any alternative options for women considering bilateral tubal ligation for contraception or ovarian cancer risk reduction?
  9. How does the cost of bilateral tubal ligation compare to OS, and is insurance likely to cover either procedure?
  10. What additional research or data is needed to better understand the safety and effectiveness of OS for ovarian cancer prevention?

Reference

Authors: Hanley GE, McAlpine JN, Kwon JS, Mitchell G. Journal: Gynecol Oncol Res Pract. 2015 Sep 17;2:5. doi: 10.1186/s40661-015-0014-1. eCollection 2015. PMID: 27231565