Original Article

Risk-Reducing Salpingectomy Versus Standard Tubal Sterilization: Lessons From Offering Women Options for Interval Sterilization

Authors: Matthew L. Zerden, MD, MPH, Tara Castellano, MD, Kemi M. Doll, MD, MS, Gretchen S. Stuart, MD, MPHTM, M. Cris Munoz, MD, Kim A. Boggess, MD

Abstract

Objectives: In women receiving sterilization, the removal of the entire fallopian tube, a procedure referred to as a risk-reducing salpingectomy (RRS), reduces subsequent ovarian cancer risk compared with standard tubal sterilization procedures. There are limited data on which surgical procedure women will choose when educated about the benefits of an RRS. Our objective was to study the proportion of women desiring sterilization that would choose an RRS.

Methods: This cohort study included women 30 years of age and older with a living biological child who requested laparoscopic sterilization at a tertiary academic hospital. Participants were given a decision aid and offered an RRS or a standard tubal sterilization procedure with titanium clips. The primary outcome was to determine the proportion of women who would choose an RRS. Other outcomes included estimated blood loss and operative time, which was compared between groups, along with complications.

Results: Fourteen of the 18 (78%) women who participated in our study chose RRS. Estimated blood loss and operating time were similar among women who underwent RRS and standard tubal sterilizations. There were no significant complications in either group. The study was ended early based on emerging data and a change in national practice patterns.

Conclusions: Because of the elective nature of sterilization and the complexities of cancer risk reduction, a patient-centered approach is beneficial for sterilization counseling. Our results support offering RRS as an alternative to standard tubal sterilization.

This content is limited to qualifying members.

Existing members, please login first.

If you have an existing account please login now to access this article or view your purchase options.

Purchase only this article ($15)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. United Nations. World contraceptive patterns 2013. http://www.un.org/en/development/desa/population/publications/family/contraceptive-wallchart-2013.shtml. Accessed December 29, 2017.
 
2. Daniels K, Daugherty J, Jones J, et al. Current contraceptive use and variation by selected characteristics among women aged 15-44: United States, 2011-2013. Natl Health Stat Rep 2015;86:1-14.
 
3. Society of Gynecologic Oncology. SGO Clinical Practice Statement: salpingectomy for ovarian cancer prevention. https://www.sgo.org/clinical-practice/guidelines/sgo-clinical-practice-statement-salpingectomy-for-ovarian-cancer-prevention. Published November 2013. Accessed December 29, 2017.
 
4. Creinin MD, Zite N. Female tubal sterilization: the time has come to routinely consider removal. Obstet Gynecol 2014;124:596-599.
 
5. Madsen C, Baandrup L, Dehlendorff C, et al. Tubal ligation and salpingectomy and the risk of epithelial ovarian cancer and borderline ovarian tumors: anationwide case-control study. Acta Obstet Gynecol Scand 2015;94:86-94.
 
6. Lessard-Anderson CR, Handlogten KS, Molitor RJ, et al. Effect of tubal sterilization technique on risk of serous epithelial ovarian and primary peritoneal carcinoma. Gynecol Oncol 2014;135:423-427.
 
7. Kurman RJ, Shih IeM. The origin and pathogenesis of epithelial ovarian cancer: a proposed unifying theory. Am J Surg Pathol 2010;34:433-443.
 
8. Westhoff C, Davis A. Tubal sterilization: focus on the US. experience. Fertil Steril 2000;73:912-922.
 
9. Tanner EJ, Long KC, Visvanathan K, et al. Prophylactic salpingectomy in premenopausal women at low risk for ovarian cancer: risk-reducing or risky? Fertil Steril 2013;100:1530-1531.
 
10. Almog B, Wagman I, Bibi G, et al. Effects of salpingectomy on ovarian response in controlled ovarian hyperstimulation for in vitro fertilization: a reappraisal. Fertil Steril 2011;95:2474-2476.
 
11. Findley AD, Siedhoff MT, Hobbs KA, et al. Short-term effects of salpingectomy during laparoscopic hysterectomy on ovarian reserve: a pilot randomized controlled trial. Fertil Steril 2013;100:1704-1708.
 
12. Ye XP, Yang YZ, Sun XX. A retrospective analysis of the effect of salpingectomy on serum antiMullerian hormone level and ovarian reserve. Am J Obstet Gynecol 2015;212:53.e1-e10.
 
13. Morelli M, Venturella R, Mocciaro R, et al. Prophylactic salpingectomy in premenopausal low-risk women for ovarian cancer: primum non nocere. Gynecol Oncol 2013;129:448-451.
 
14. Boeckxstaens A, Devroey P, Collins J, et al. Getting pregnant after tubal sterilization: surgical reversal or IVF? Hum Reprod 2007;22:2660-2664.
 
15. McAlpine JN, Hanley GE, Woo MM, et al. Opportunistic salpingectomy: uptake, risks, and complications of a regional initiative for ovarian cancer prevention. Am J Obstet Gynecol 2014;210:471.e1-e11.
 
16. Jamieson DJ, Hillis SD, Duerr A, et al. Complications of interval laparoscopic tubal sterilization: findings from the United States Collaborative Review of Sterilization. Obstet Gynecol 2000;96:997-1002.
 
17. Peterson HB. Sterilization. Obstet Gynecol 2008;111:189-203.