471 Out with the old, in with the new-salpingectomy method matters-a randomized controlled trial

Abstract

To estimate whether “traditional” salpingectomy (TS)-“Knot and Cut” technique, compared with “LigaSure” salpingectomy (LS) for sterilization at the time of cesarean delivery (CD) increases operating time and complication rates. A randomized controlled trial performed at a single tertiary medical center. Women undergoing elective CD desiring sterilization underwent either TS or LS. Salpingectomies were performed by experienced OBGYNs. LS was performed with the LigaSure PreciseTM. The primary outcome was salpingectomy time. Secondary outcomes included total CD time and bleeding associated parameters. Based on power analysis and an anticipated 10-minute difference between the 2 procedures, 21 patients were required for each group to reach statistical significance. Fifty-one women were enrolled, with 26 undergoing LS and 25 undergoing TS. Salpingectomy could not be completed in 2 patients in the TS group (due to adhesions) and was completed in all patients in the LS group (though adhesion rate was not different). There were 6 cases of conversion from TS to LS due to excess blood loss during the procedure. Demographic and obstetric information were equivalent between groups. TS time was significantly longer compared to LS with no significant difference in the total length of CD time (16.16±9.53 minutes vs. 5.19±3.57 minutes, p<0.0001 and 88.92±17.87 minutes vs. 88.23±19.85 minutes, p=0.89, respectively). Estimated blood loss and need for blood transfusion were significantly higher in the TS compared to the LS group (928.08±414.66 ml vs. 677.15±380.42 ml, p=0.029 and 20% vs. 0%, p=0.016, respectively). Hospitalization time was significantly longer in the TS compared to the LS group (5.24±2.27 days vs. 3.92±2.01 days, p=0.034). “Traditional” salpingectomy is associated with longer surgical time, increased blood loss and need for blood transfusion, need for conversion between surgical techniques and longer hospitalization time compared to “LigaSure” salpingectomy. In practices where “LigaSure” is available, it should be preferred for salpingectomy over alternative methods.View Large Image Figure ViewerDownload Hi-res image Download (PPT)