The removal of fallopian tubes during sterilisation is about as safe as sterilisation procedures that damage the tubes but leave them intact, a recent study suggests, a finding that could help reduce some women’s risk of ovarian cancer.
Swedish researchers found little difference in the risk for surgical complications between the two methods, they write in the journal The Lancet Regional Health – Europe.
They compared the risk of salpingectomy, in which the fallopian tubes are removed, and tubal occlusion, an umbrella term for a variety of more common sterilisation techniques that damage the fallopian tubes but leave them in the body.
The Washington Post reports that the study involved women under age 50 who planned on laparoscopic sterilisation at one of 41 Swedish gynaecological departments. They were randomly assigned to either have their fallopian tubes removed or be sterilised by tubal occlusion. Ultimately, 473 of the women had salpingectomies, and 499 had other tubal occlusion procedures.
Patients whose fallopian tubes were removed had slightly longer surgeries, clocking in at about 45 minutes vs 30 minutes for those who had the traditional procedure. Most complications with both procedures were minor.
Among the women whose tubes were removed, 8.1% had surgical complications within eight weeks, compared with 6.2% of the women after tubal occlusion.
Laparoscopic salpingectomies’ safety “has now been established,” the authors wrote.
Cancer avoidance a win
Because many ovarian cancers start in the fallopian tubes, removing them is thought to decrease risk.
“Every case of ovarian cancer we can avoid is a big win for society and for those women who would otherwise have been affected,” said the study’s lead author, Annika Strandell, associate professor at Sahlgrenska Academy at the University of Gothenburg and a consultant gynaecologist at Sahlgrenska University Hospital. “Surgery to remove fallopian tubes during sterilisation could provide an opportunity to prevent many new cases of cancer.”
Next, the researchers will investigate the potential effects fallopian tube removal could have on ovarian function and menopause.
Study details
Salpingectomy versus tubal occlusion in laparoscopic sterilisation (SALSTER): a national register-based randomised non-inferiority trial
Annika Strandell, Leonidas Magarakis, Karin Sundfeldt, Mathias Pålsson, Per Liv, Annika Idah.
Published in The Lancet Regional Health Europe on 11 August 2024
Summary
Background
Opportunistic salpingectomy to reduce ovarian cancer incidence has become increasingly common despite the lack of randomised trials investigating its safety. In SALSTER, we tested whether salpingectomy for laparoscopic sterilisation is non-inferior to tubal occlusion regarding complications up to eight weeks postoperatively.
Methods
SALSTER is a register-based randomised non-inferiority trial in which 41 gynaecological departments in Sweden participated. After being reported to The Swedish National Quality Register of Gynaecological Surgery (GynOp) for laparoscopic sterilisation, women aged <50 years received study information and could consent to participation online. If eligible, randomisation was performed by the examining/operating gynaecologist before surgery, with stratification for centre, and allocation 1:1 to salpingectomy or tubal occlusion. Blinding was attempted for patients but was impossible for surgeons. The first primary outcome, any complication up to eight weeks postoperatively, was routinely reported in GynOp through physician assessment of patient questionnaires, medical records and personal contact. Complications up to eight weeks post-operatively, a primary safety outcome, were analysed in the per-protocol population. The non-inferiority margin for the difference in the absolute risk of complications was defined as ten percentage points. Missing data were handled using multiple imputation.
Findings
Between 4 April 2019, and 31 March 2023, 539 women were randomised to salpingectomy and 527 to tubal occlusion. In the salpingectomy and tubal occlusion arms, 40 and 18 women discontinued their participation in the trial and another 26 and 10 did not receive the allocated surgery, respectively. Calculated on imputed data, any complication up to eight weeks post-operatively occurred in 8.1% (38.5/473) of patients after salpingectomy and in 6.2% (31.0/499) of patients after tubal occlusion. The risk difference was 1.9 percentage points (95% confidence interval −1.4 to 5.3).
Interpretation
Laparoscopic salpingectomy is non-inferior to tubal occlusion regarding complication rates up to eight weeks post-operatively.
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