Salpingectomy is the surgical removal of one or both fallopian tubes. Fallopian tubes are structures that allow eggs to travel from the ovaries to the uterus. Salpingectomy may be needed to treat ectopic pregnancy or infection.
Some people choose to have both fallopian tubes removed as a permanent form of birth control or to lower their risk of ovarian cancer. Scientists recently discovered that most ovarian cancers likely start as tiny tumors in the fallopian tubes ― not in the ovaries.
What You Need to Know
- Salpingectomy involves removal of one or both fallopian tubes.
- It may be performed to treat ectopic pregnancy. An ectopic pregnancy occurs when an embryo grows outside of the uterus, such as one that takes root in the fallopian tube.
- Bilateral salpingectomy means removal of both fallopian tubes. It is a permanent form of birth control for people who do not desire future pregnancies. A person can become pregnant with only one fallopian tube.
- Salpingectomy can reduce the risk of cancer of the fallopian tube, the ovary and the peritoneum (the membrane that surrounds the abdominal organs).
- Salpingectomy to prevent cancer of the fallopian tube, the ovary or the peritoneum can be performed at the time of another abdominal procedure and is recommended for those who do not desire future pregnancies.
What is a salpingectomy?
Salpingectomy means fallopian tube excision. Fallopian tubes are hollow structures through which eggs travel from the ovaries to the uterus. The term can refer to procedures that remove one or both fallopian tubes entirely, or that take out only parts of the fallopian tube(s).
The decision to remove all or part of a fallopian tube depends on why the surgery is being performed, the age and health of the patient and their fertility concerns.
Partial salpingectomy is removal of part of the fallopian tube.
Complete salpingectomy is a procedure to completely remove one (unilateral) or both (bilateral) fallopian tubes. Stone points out that removing both fallopian tubes does not cause menopause because the fallopian tubes do not make hormones.
Salpingo-oophorectomy is the removal of the fallopian tube and the ovary. It can be unilateral (removal of one fallopian tube and one ovary, typically on the same side) or bilateral (removal of both fallopian tubes and one or both ovaries).
“When both ovaries are removed, the person will experience menopause, because the ovaries make hormones and their removal causes this to stop,” says Stone, who notes that bilateral oophorectomy at a young age has been shown to increase the risk of heart disease, osteoporosis and other conditions. “In the event one ovary is removed, hormone production from one ovary is all that is needed.”
Salpingectomywith ovarian preservation means that a person maintains estrogen and other hormone levels because the ovaries are kept in place: Only the fallopian tubes are removed.
Opportunistic salpingectomy is elective removal of both fallopian tubes during another abdominal surgery (such as a gallbladder surgery, a hernia operation, cesarean birth or hysterectomy) as a measure to prevent cancer of the fallopian tube, ovary or peritoneum.
Why would a salpingectomy be recommended?
There are several reasons why a doctor may recommend salpingectomy to treat a patient. Since the surgery can affect both fertility and cancer prevention, it is important to communicate with the doctor and to understand the impact of the procedure.
An ectopic pregnancy is a complication of pregnancy that involves a fertilized egg growing outside of the uterus. An ectopic pregnancy that takes root in a fallopian tube cannot successfully grow into a baby, and may eventually cause the tube to rupture, causing life-threatening bleeding. In some cases, an ectopic pregnancy is a surgical emergency.
Salpingectomy to remove all or part of the affected fallopian tube may be necessary to manage an ectopic pregnancy. The Gyn/Ob surgeon works with the patient to preserve fertility when possible.
Permanent Birth Control
Salpingectomy and tubal ligation (having the fallopian tubes “tied”) are both methods of permanent birth control. People may choose permanent birth control for health reasons or personal preference.
Whereas tubal ligation involves using a band or clamp to close the fallopian tubes, salpingectomy interrupts the fallopian tubes by removing a middle segment of them (partial salpingectomy) or detaches the fallopian tubes from the uterus and fully removes them (complete salpingectomy).
While both tubal ligation and complete salpingectomy are very effective in preventing pregnancy, complete salpingectomy is most effective for contraception and provides the greatest benefit in terms of cancer prevention.
Bilateral Salpingectomy for Cancer Prevention
“Ovarian cancer is the most dangerous of all gynecologic cancers because it is usually diagnosed when it is advanced and there is little chance of curative treatment,” Stone says.
Shih says recent research shows that some forms of ovarian cancer do not begin in the ovary itself, but in the fingerlike projections at the end of the fallopian tubes called the fimbriae. Cancerous cells growing in this area spread to the ovary and to the peritoneum, the membrane surrounding organs in the abdomen. Extra-ovarian primary peritoneal carcinoma (EOPPC) is a form of cancer that affects the peritoneum and that may originate in cancerous cells from the fallopian tubes.
“Because many ovarian cancers start in the fallopian tubes, we can lower the risk for ovarian cancer by removing the fallopian tubes for people who do not desire future pregnancy,” Stone explains.
People may have a higher risk of ovarian cancer if they have had breast cancer or if their family has a history of breast, ovarian, pancreatic or colon cancer. Genetic testing might be recommended.
Stone says, “People with a hereditary risk of cancer, including those with BRCA1 and BRCA2 gene mutations or those associated with Lynch syndrome, have more than 1% to 2% lifetime risk of ovarian cancer. For them, removal of both fallopian tubes and ovaries, typically between the ages of 35 to 50, depending on the gene mutation, is the recommended standard of care. This will be the case until we have the results of prospective research in the coming years.”
Opportunistic Salpingectomy for Cancer Prevention
Even people without a known risk factor for ovarian cancer can benefit from fallopian tube removal.
“Salpingectomy lowers the risk of ovarian cancer in all people,” Stone emphasizes. “It is critical to understand that people who are average risk for ovarian cancer (those not known to have a hereditary risk) are eligible for salpingectomy for ovarian cancer prevention once they have completed childbearing.
“Salpingectomy to lower the risk of ovarian cancer can be done at the same time as another planned abdominal surgery, such as at the same time as having a gallbladder removed or a hernia surgery. This is called opportunistic salpingectomy — taking the opportunity to remove both fallopian tubes at the time of another abdominal surgery to prevent cancer of the ovary, fallopian tube and peritoneum.
“Opportunistic salpingectomy is recommended for cancer prevention in people who do not have a hereditary risk of ovarian cancer due to BRCA and other gene mutations.”
“Researchers are studying whether the same risk reduction can be achieved with just removing the fallopian tubes and leaving the ovaries in place for people who have a genetic predisposition due to gene mutations like BRCA. But for now, opportunistic salpingectomy is recommended for people who have average risk of ovarian cancer (1% to 2% lifetime risk).
“At present, we do not have an effective screening test for ovarian cancer. Pap smears do not screen for ovarian cancer. However, future research hopes to identify subtle changes in cells collected during Pap tests, which might identify people at risk so that they can choose risk-reducing surgery sooner.”
Salpingectomy: What to Expect
Stone explains that laparoscopic salpingectomy can be performed as a same-day laparoscopy procedure at a hospital or surgical center.
“Laparoscopic means the surgeon performs surgery using small incisions (less than ½ inch) on the abdomen. Same day means you will not need to be admitted to a hospital and can return home the day of surgery. It is important to arrange for a ride home after a salpingectomy since the procedure typically requires general anesthesia,” she says.
In some cases, a procedure called mini laparotomy can be used to perform a salpingectomy. The surgeon accesses the fallopian tubes through one small incision in the pubic area. In this case, a person might elect to have spinal anesthesia instead of general anesthesia. Spinal anesthesia is a nerve block that eliminates sensation in the lower part of your abdomen. It is commonly used for cesarean sections.
Having fallopian tubes removed while you are having another abdominal procedure is typically straightforward, Stone says. “When salpingectomy is added to another surgical procedure on the abdomen, it typically takes only minutes to perform and does not add significant risk to the surgical experience. Salpingectomy can be done at the same time as an endoscopic abdominal procedure (laparoscopic or robotic) or as an open abdominal procedure (single, long incision on the abdomen).”
Salpingectomy: What Happens
Salpingectomy that is performed with a laparoscope typically requires three small incisions, one near the navel and others in the lower abdomen (belly).
The surgeon locates the fallopian tubes and examines them along their entire length. Using surgical instruments such as forceps (a tweezer-like instrument), the surgeon grasps the tube and detaches it from the ovary and uterus, often using an energy device to seal and divide small vessels along the way.
Recovering from Salpingectomy
- It is important to follow the surgeon’s instructions after the procedure. Talk to your doctor about when it is safe to start having sex again.
- Salpingectomy procedures for contraception are effective right away. You will not need to use other contraception methods once you recover from the surgery. However, the procedure does not protect against sexually transmitted infections, so people should continue to use condoms to prevent them.
- Recovery typically takes one to three weeks after the procedure and may take longer following a cesarean section or childbirth.
Risks and Complications of Salpingectomy
Stone points out that salpingectomy performed laparoscopically is low risk. Rarely, patients can have the following complications from the surgery:
- Unintended injury to organs in the abdomen
- Scar tissue
- Chronic pain
- Need for a longer incision (called a laparotomy)