Comparative Study of Ovarian Function in Patients Undergoing Hysterectomy With or Without Bilateral Complete Salpingectomy

Abstract

Hysterectomy is one of the most common gynaecological procedures performed in clinical practice. Over the past decade, there is increasing evidence that the majority of high-grade serous ovarian cancers arise in the fallopian tube and not primarily in the ovary. This new theory has led to an opportunity to prevent epithelial ovarian cancer by the addition of the prophylactic bilateral salpingectomy in all surgical procedures for average-risk women, not carrying BRCA mutations, who completed their reproductive goal (American Cancer Society and the American College of Obstetricians and gynaecologists). The rising trend in salpingectomy has been associated with a rising concern over its potentially damaging effect on ovarian reserve due to possible concomitant damage of ovarian blood supply given the close proximity of tubal and ovarian arteries. In view of the above arguments the present study was planned to compare the effect on ovarian function in patients undergoing hysterectomy with or without bilateral complete salpingectomy. 50 premenopausal women planned for hysterectomy for benign indications were randomized to undergo hysterectomy with bilateral complete salpingectomy (group A) or hysterectomy alone (group B). Blood sample was collected on pre-operative period for baseline FSH, LH and Serum oestradiol (E2) level estimation. Group A (n = 25) patients underwent total hysterectomy with complete excision of the fallopian tubes bilaterally and in group B (n = 25) patients’ classical approach was done and ovaries and fallopian tubes were left in situ. Duration of surgery, change in haemoglobin on third post-operative day, post-op complications, and total duration of hospital stay was noted. The follow up of these patients was done 3 months after surgery and again blood sample was taken for serum FSH, LH and oestradiol (E2) level estimation. Baseline demographic and clinical characteristics were similar between the two groups. There was also no difference in operative outcomes such as operative time, intra-operative blood loss or complications between the two groups. Mean FSH, LH, and oestradiol values were unchanged after both the techniques. Bilateral complete opportunistic salpingectomy at the time of hysterectomy does not appear to have any short-term deleterious effects on ovarian function or increased surgical risk.