Overview of Bilateral Salpingectomy

March 17th, 2025

Bilateral salpingectomy is the surgical removal of both fallopian tubes. It has gained prominence in recent years as a preferred method for sterilization and risk reduction for ovarian cancer.

Unlike tubal ligation, which simply blocks or ties the tubes, salpingectomy completely removes them, eliminating any possibility of natural conception. This guide explores the indications, procedural details, benefits, risks, and emerging research surrounding bilateral salpingectomy.

Indications for bilateral salpingectomy

1. Permanent sterilization

Bilateral salpingectomy is a definitive contraceptive method for individuals who no longer wish to conceive. It provides a highly effective alternative to tubal ligation, with a lower risk of failure.

2. Risk reduction for ovarian cancer

Considered the most lethal gynecologic malignancy, epithelial ovarian cancer is believed to originate in the fallopian tubes in many cases. Prophylactic salpingectomy is recommended for individuals at high risk, particularly those with BRCA1/BRCA2 mutations or a strong family history of ovarian cancer.

3. Ectopic pregnancy prevention

Individuals with a history of ectopic pregnancies may undergo bilateral salpingectomy to prevent future occurrences. Since the fallopian tubes are the primary site of ectopic implantation, removing them eliminates the risk.

4. Adjunct to other gynecologic surgeries

Bilateral salpingectomy is often performed alongside hysterectomy (removal of the uterus) or oophorectomy (removal of the ovaries) for conditions, such as:

• Endometriosis

• Pelvic inflammatory disease (PID)

• Fibroids

• Chronic pelvic pain

• Heavy menstrual bleeding unresponsive to conservative treatments

• Precancerous lesions in the fallopian tubes

Surgical procedure

Preoperative considerations

• Patient evaluation: To assess pelvic anatomy, a comprehensive medical history, physical examination, and imaging studies (such as an MRI or ultrasound) are conducted.

• Counseling: Patients are counseled about the permanent nature of the procedure, potential risks, and alternative contraceptive options.

• Anesthesia: The procedure is typically performed under general anesthesia.

Surgical techniques

1. Laparoscopic bilateral salpingectomy

• The most common approach, this uses small abdominal incisions and a laparoscope.

• Carbon dioxide insufflation creates space in the abdominal cavity.

• The fallopian tubes are carefully dissected and removed.

• Minimal recovery time with reduced postoperative pain.

2. Open (laparotomic) bilateral salpingectomy

• Performed via a larger abdominal incision, this is performed typically in cases of severe adhesions or when combined with other major surgeries (e.g., hysterectomy).

• There is a longer recovery compared to laparoscopy.

3. Vaginal salpingectomy

• This is occasionally performed during vaginal hysterectomy.

• This is less commonly used due to technical challenges.

Benefits of bilateral salpingectomy

1. Highly effective sterilization

Unlike tubal ligation, which carries a small risk of tubal recanalization and pregnancy, bilateral salpingectomy completely removes the fallopian tubes, eliminating the risk of spontaneous pregnancy.

2. Reduction in ovarian cancer risk

Studies suggest that removal of the fallopian tubes significantly lowers the risk of high-grade serous ovarian cancer, particularly in high-risk individuals. The American College of Obstetricians and Gynecologists (ACOG) supports opportunistic salpingectomy for ovarian cancer prevention.

3. Decreased risk of ectopic pregnancy

Since ectopic pregnancies typically implant in the fallopian tubes, their removal eliminates this risk.

4. Potentially lower risk of pelvic inflammatory disease

Fallopian tubes are often affected by PID. Their removal may reduce the risk of recurrent infections.

5. Potential long-term health benefits

Some studies suggest that fallopian tube removal may reduce the risk of certain hormonal imbalances. Reduced exposure to potential inflammatory processes linked to the fallopian tubes.

Risks and complications

1. Surgical risks

Bleeding, infection, and injury to surrounding structures (e.g., bladder, bowel) can occur, though rare with laparoscopic techniques. There is also a risk of adhesions forming post-surgery.

2. Potential impact on ovarian function

Some studies suggest that removing the fallopian tubes may slightly reduce ovarian blood supply, potentially affecting ovarian reserve. However, evidence remains inconclusive, and most women maintain normal ovarian function.

3. Postoperative pain and recovery

Laparoscopic procedures typically have shorter recovery times (one to two weeks), while open surgery may require longer healing (four to six weeks). Patients may experience temporary bloating and mild discomfort postoperatively.

4. Psychological considerations

Some individuals may experience regret, particularly if they later desire pregnancy. Preoperative counseling is crucial to ensure informed decision-making.

Comparison with alternative sterilization methods

Emerging research and future perspectives

Salpingectomy vs. salpingo-oophorectomy

• Studies are evaluating whether removing only the fallopian tubes provides the same ovarian cancer risk reduction as removing both tubes and ovaries.

• Preserving the ovaries helps maintain hormonal balance and prevents premature menopause.

Impact on fertility treatments

• Those who undergo bilateral salpingectomy cannot conceive naturally but may still achieve pregnancy via in vitro fertilization (IVF).

• Some research explores the impact of salpingectomy on ovarian response in IVF patients.

Prophylactic salpingectomy for low-risk individuals

• The concept of opportunistic salpingectomy during routine gynecologic procedures is being studied as a preventive measure against ovarian cancer.

• Studies are examining the long-term impacts on overall reproductive health.

Bilateral salpingectomy is a highly effective and increasingly recommended procedure for sterilization and ovarian cancer risk reduction. It offers significant advantages over traditional tubal ligation, including enhanced protection against ovarian cancer and ectopic pregnancy.

While the procedure carries some risks, the benefits often outweigh them for many patients. Ongoing research continues to refine recommendations, particularly regarding its role in cancer prevention and fertility preservation. As evidence grows, bilateral salpingectomy may become the standard of care for many patients undergoing gynecologic surgery.