Our Summary

This research paper looks at how often both ovaries and fallopian tubes are removed (bilateral salpingo-oophorectomy) when a woman has a hysterectomy (removal of the uterus), and whether this additional procedure is always necessary. The study used data from six hospitals in Ontario, Canada between July 2016 and June 2018.

The researchers found that in 28% of the cases, both the ovaries and fallopian tubes were removed at the same time as the uterus. In 68% of these cases, there was a clear medical reason to do so, based on the diagnosis before the operation. However, there was a difference between hospitals in how often the procedure was necessary. Additionally, the removal of ovaries and tubes was more likely to be indicated at academic centers compared to community hospitals, and when the surgeon had special fellowship training.

The study also found that in some cases, removing the ovaries and tubes might not have been necessary. In 44% of the cases where there was no clear medical reason before the operation, the patient was under 51 years of age, and in 58% of these cases, there was no sign of disease in the ovaries or tubes during the operation. The researchers concluded that it might have been reasonable to leave the ovaries and tubes in place in about 8% of the cases.

In short, the study suggests that there may be some unnecessary removal of ovaries and tubes during hysterectomies, particularly by general surgeons and at community hospitals.

FAQs

  1. What were the main factors considered in determining the necessity of bilateral salpingo-oophorectomy during hysterectomy?
  2. What percentage of bilateral salpingo-oophorectomy procedures were deemed unnecessary based on preoperative diagnosis and age of the patient?
  3. Were there any noticeable differences in the rate of indicated bilateral salpingo-oophorectomy between academic centers and community hospitals?

Doctor’s Tip

A helpful tip a doctor might tell a patient about salpingo-oophorectomy is to discuss the potential risks and benefits of removing both fallopian tubes and ovaries during hysterectomy. It is important to consider factors such as age, preoperative diagnosis, presence of endometriosis or adhesions, and the surgeon’s training in determining whether bilateral salpingo-oophorectomy is necessary. Ovarian preservation may be a viable option for some patients, so it is crucial to have a thorough discussion with your healthcare provider before making a decision.

Suitable For

Patients who are typically recommended for salpingo-oophorectomy are those with preoperative indications such as ovarian pathology, endometriosis, adhesions, or a high risk of developing ovarian cancer. Younger patients under the age of 51 with benign preoperative diagnoses and no intraoperative findings of endometriosis or adhesions may not be good candidates for bilateral salpingo-oophorectomy and may be considered for ovarian preservation. Surgeons with specialized training, such as fellowship-trained surgeons, are more likely to perform indicated bilateral salpingo-oophorectomy compared to generalists. Overall, the decision to recommend salpingo-oophorectomy should be based on individual patient factors and preoperative indications.

Timeline

Before salpingo-oophorectomy:

  • Patient may have been experiencing symptoms such as pelvic pain, abnormal bleeding, or other gynecological issues.
  • Patient may have undergone diagnostic tests such as ultrasounds or biopsies to determine the cause of their symptoms.
  • Patient may have consulted with their gynecologist or other healthcare providers to discuss treatment options, including the possibility of undergoing a hysterectomy with bilateral salpingo-oophorectomy.
  • Patient may have received counseling on the potential risks and benefits of the surgery, as well as alternative treatment options.

After salpingo-oophorectomy:

  • Patient undergoes the surgical procedure, which involves the removal of the uterus, fallopian tubes, and ovaries.
  • Patient may experience pain and discomfort in the days following the surgery, which can be managed with pain medication.
  • Patient may stay in the hospital for a few days for recovery, depending on the type of surgery performed.
  • Patient will have follow-up appointments with their healthcare provider to monitor their recovery and discuss any concerns or complications.
  • Patient may experience menopausal symptoms such as hot flashes, mood swings, and vaginal dryness due to the loss of ovarian function. Hormone replacement therapy may be recommended to manage these symptoms.
  • Patient may undergo additional testing to monitor their hormone levels and overall health following the surgery.

What to Ask Your Doctor

  1. What are the potential benefits of undergoing bilateral salpingo-oophorectomy during my hysterectomy?
  2. What are the potential risks and complications associated with bilateral salpingo-oophorectomy?
  3. What are the alternatives to bilateral salpingo-oophorectomy for my condition?
  4. How will bilateral salpingo-oophorectomy affect my hormone levels and menopausal symptoms?
  5. What is the likelihood that bilateral salpingo-oophorectomy will be indicated based on my preoperative diagnosis?
  6. Are there any specific factors (such as age, presence of endometriosis/adhesions) that may influence the decision to perform bilateral salpingo-oophorectomy in my case?
  7. What is your experience and training in performing bilateral salpingo-oophorectomy?
  8. Are there any long-term consequences of not undergoing bilateral salpingo-oophorectomy?
  9. How will bilateral salpingo-oophorectomy impact my future fertility and reproductive health?
  10. Are there any additional tests or consultations that I should consider before making a decision about bilateral salpingo-oophorectomy?

Reference

Authors: Wong J, Murji A, Sunderji Z, Chow O, Shapiro J, Wolfman W, Shirreff L. Journal: Menopause. 2020 Sep 4;28(1):8-11. doi: 10.1097/GME.0000000000001652. PMID: 32898023