552: Safety of salpingectomy at time of cesarean section

Abstract

The most common methods of sterilization during cesarean delivery rely on excision of a mid-segment of the fallopian tube. Contemporary data suggests ovarian cancers may originate in the fimbriae of the fallopian tube; therefore, a strategy of prophylactic salpingectomy (SL) has been adopted during gynecologic surgery. The purpose of this study was to evaluate the safety of SL compared to traditional mid-segment excision at time of cesarean through change in perioperative hemoglobin (Hgb). We retrospectively evaluated patients undergoing concurrent cesarean delivery and sterilization procedures between 1/1/2015 and 3/31/2017 in the Mayo Clinic Health System. In order to test for non-inferiority, 30 patients in each arm (tubal ligation (TL) and SL) were required to detect a pre and postoperative Hgb difference of 0.5 mg/dL between groups with a power of 80%. Exclusion criteria included: age <18 years, BMI>50 kg/m2, endometriosis, other concurrent surgical procedures, bleeding disorders, postpartum hemorrhage due to atony, trial of labor after cesarean, and the presence of ovarian masses. 89 patients met inclusion criteria with 41 (46.1%) patients undergoing SL. There was a significant difference in ethnicity between the two groups (p-value=0.004) with Caucasian patients undergoing SL more commonly. The majority of patients underwent repeat cesareans (80%) and there were no reported infections, repeat laparotomies, or blood transfusions in either group. There was no evidence of inferiority with a mean difference in pre and postop Hgb of 0.18 mg/dL (95% lower bound of 0.46, p-value: 0.99) with less reduction in Hgb from SL. The mean length of the procedure was 9.9 minutes (95% CI 2.8 to 12.5, p-value <0.001) longer for a SL procedure. The primary difference in procedure time was amongst Pomeroy tubal ligations, compared to Parkland and the two SL types (p-value <0.05). This study provides evidence that the practice of salpingectomy at the time of cesarean delivery may be safe and should form the basis of prospective trials.View Large Image Figure ViewerDownload Hi-res image Download (PPT)