Bilateral Partial Salpingectomy Research Articles

Primary fallopian tube carcinoma diagnosed 29 years after bilateral partial salpingectomy: A case report.

SynopsisSalpingectomy has a reported theoretical decreased risk of tubal and ovarian cancers. Here we describe a case 29 years after partial salpingectomy.

Robotic Tubal Reanastomosis Following Bilateral Partial Salpingectomy of Tubal Infundibula

<h3>Study Objective</h3> Demonstrate how to perform a robotic tubal reanastomosis in a patient who previously had a bilateral partial salpingectomy of the infundibula. <h3>Design</h3> Case report. <h3>Setting</h3> The patient was positioned in dorsal lithotomy and Trendelenburg. 4 arms and an assistant port were used. <h3>Patients or Participants</h3> One patient case is illustrated in this video. <h3>Interventions</h3> Robotic tubal reanastomosis. <h3>Measurements and Main Results</h3> The patient achieved a spontaneous intrauterine pregnancy after the surgery. <h3>Conclusion</h3> Tubal reanastomosis following bilateral partial salpingectomy of the infundibula is challenging, but pregnancy is still possible. Care should be taken to excise the mid-portion of the ampulla if a bilateral partial salpingectomy is performed in case the patient has regret and desires a reversal.

Opportunistic salpingectomy versus traditional partial salpingectomy at the time of cesarean delivery: a non-inferiority randomized controlled trial

Background: Ovarian cancer has the highest mortality of all gynecologic malignancies, howeverthere is no proven effective screening for ovarian cancer. Evidence suggests that epithelial ovarian cancer begins in the fallopian tubes. Prophylactic bilateral total salpingectomy has been shown to reduce the risk of epithelial ovarian cancer and is now recommended to be considered at the time of sterilization procedures. There are limited well designed clinical trials that compare the safety and feasibility of total salpingectomy to that of traditional partial salpingectomy for tubal sterilization in obstetrics. We thus conducted a randomized controlled trial to assess the safety of bilateral total salpingectomy at the time of cesarean delivery. Methods: We conducted a non-inferiority randomized controlled trial at the Mayo Clinic, Rochester, Minnesota. Women age 21 years and older who were undergoing cesarean delivery and desired concomitant sterilization were enrolled between May 17, 2017 and July 16, 2018. Stratified randomization was performed based on number of previous cesarean deliveries and their Basal Metabolic Index, into a bilateral total salpingectomy (BTS) group and bilateral partial salpingectomy (BPS) group. All salpingectomies were performed using clamps and suture. The primary outcome was to compare the mean peri-operative hemoglobin change for both groups. Secondary objectives included sterilization completion time, postoperative length of stay, estimated blood loss, postoperative pain and adverse events. Results: Of the 111 women screened, 40 were enrolled and randomized. Of these, 38 underwent the assigned procedure (18 BTS, 20 BPS). No difference in Mean ± SD hemoglobin drop between groups (1.4 ± 0.7 g/dL for the BPS group and 1.8 ± 1.0 g/dL for the BTS group, p = 0.08), however the point estimate of –0.4 is very close to the non-inferiority margin of –0.5, and the CI widely exceeds the non-inferiority margin (95% CI –0.99, 0.17). Therefore non-inferiority was not shown. Mean time to completion of sterilization procedure was significantly longer in the BTS group (16.3 ± 5.6 minutes for the BTS group vs 5.1 ± 1.6 minutes for the BPS group, p &lt; 0.01). No significant differences for other outcome measures. Conclusions: Bilateral total salpingectomy is not non-inferior to tradiational bilateral partial salpingectomy with regards to postoperative hemoglobin drop, and is associated with a small increase in operative time. There, however, was no difference in adverse events, postoperative length of stay and postoperative pain between the two groups. This information may be helpful when counseling patients.

Essure Device Migration after Bilateral Partial Salpingectomy at the Time of Cesarean Delivery

A 42-year-old woman, gravida 10, para 10, presented with constant central pelvic pain and dyspareunia since cesarean delivery and partial salpingectomy 16 months earlier. She had no history of pelvic pain and had undergone Essure placement 13 years earlier with 3 subsequent unintended pregnancies. Parkland bilateral partial salpingectomy was performed at an outside institution during her final delivery, with no attempt to remove the microinserts. There was no documentation of the rationale for retention of microinserts or for partial rather than complete salpingectomy.

A rare case report of bilateral ruptured tubal ectopic pregnancy

Implantation of the fertilized ovum outside the uterine cavity is called ectopic gestation. The common presenting symptoms are per vaginal bleeding till 12 weeks, pain in the lower abdomen, and absence of menses. ß-HCG level is increased (>1000IU/L) and transvaginal ultrasonography shows an empty uterus. These findings essentially confirm the diagnosis. In this, we have a 23-year-old, G2P1L1 with a history of 3 months of amenorrhea, presenting to the labor ward with a history of per vaginal bleeding and lower abdominal pain. The diagnosis was 10 weeks right-sided ruptured ectopic pregnancy and intraoperatively found to be ruptured ectopic pregnancy in both fallopian tubes which we managed successfully by performing emergency laparotomy with bilateral partial salpingectomy.

Impact of bilateral total salpingectomy versus standard tubal ligation at time of cesarean section on ovarian reserve: A randomized controlled trial

Aim of the work: The objective of this trial was to compare between bilateral total salpingectomy (BTS) as a theoretically more effective ovarian cancer (OvCa) risk-reducing primary prevention and bilateral partial salpingectomy (BPS) [stander tubal ligation (STL)] procedures at time of cesarean section (CS) for parturients who completed their reproductive desire and requesting permanent sterilization regard to the impacts of both procedures on ovarian reserve parameters at one year post-sterilization as well as the surgical consequences of both procedures.Patients and Methods: This is a prospective, randomized, open-label, concealed allocation, parallel group, superiority trial was conducted at three surgical sites in El-Qulobia, Egypt including Benha University Hospital, Obstetrics and Gynecology Department between October 2015 and October 2017. 120 parturients undergoing CS were allocated to BTS (intervention group) (60) and BPS (control group) (60). Main outcomes were one year post-sterilization differences in ovarian reserve (OR) parameters including hormonal as well as two-dimensional and three-dimensional transvaginal ultrasonographic parameters ; namely, anti-mullerian hormone (AMH) (ng/ml), follicular stimulating hormone (FSH) (mIu/ml), peak systolic velocity (PSV) (cm/s), antral follicle count (AFC) (n), vascular index (VI) (%), flow index (FI) (0-100), vascular flow index (VFI) (0-100), calculated ovarian age [OvAge (year)] and ovarian volume. Ancillary outcomes were surgical feasibility and surgical consequences.Results: 102 women completed the one-year follow up (85%), 50 in the BTS group and 52 in the BPS group and there were no statistically significant differences regarding the ovarian reserve parameters at one year post-sterilization including AMH, FSH, AFC, VI, FI, VFI OvAge and ovarian volume (P > 0.05). Also, there were no statistically significant differences regarding items included in surgical. consequences comparison (P > 0.05) as well as surgical sterilization feasibility (100% vs 100%, p = 1). Also, there were no apparent complications due to sterilization procedures in both groups.Conclusion: Impacts of bilateral total salpingectomies (BTS) on ovarian reserve as sterilizing procedure during cesarean section as well as rates of surgical consequences are similar with that of bilateral partial salpingectomies (BPS) (STL). So, BTS could be recommended over BPS (STL) for women completing their reproductive desire, despite its better efficacy as ovarian cancer reducing surgery as well as its better clinical and sterilizing efficacy remained to be elucidated. .

Opportunistic salpingectomy during postpartum contraception procedures at elective and unscheduled cesarean delivery

ObjectiveTo compare intra- and postoperative surgical complications of opportunistic bilateral total salpingectomy during postpartum permanent contraception procedures in elective and unscheduled cesarean delivery. Study designWe conducted a retrospective cohort study (2010–2017) of women who had postpartum permanent contraception procedures during cesarean delivery, and we collected baseline characteristics, scheduling of delivery (elective versus unscheduled), operative time, estimated blood loss (EBL) and surgical complications (bleeding, iatrogenic injury, infection, anemia and relaparotomy). We classified patients according to contraceptive technique: bilateral total salpingectomy, bilateral partial salpingectomy with or without fimbriae, and other methods. ResultsFive hundred twenty-eight women underwent postpartum permanent contraception procedures, 245 (46.4%) had bilateral total salpingectomy, 239 (45.3%) had bilateral partial salpingectomy, and 48 (8.3%) underwent other methods. We did not find differences in baseline characteristics, operative time and EBL among postpartum permanent contraception groups. Unscheduled cesarean delivery did not influence the choice of postpartum permanent contraception technique (p=.22). Postpartum permanent contraception-related intraoperative bleeding occurred in 1 (0.4%) and 2 (0.9%) patients, respectively, in bilateral total and partial salpingectomy group (p=.23). Postoperative complications were 13 (5.3%) and 6 (2.5%), respectively, in bilateral total and partial salpingectomy groups (p=.11). Subgroup analysis confirmed no differences for intra- and postoperative complications during unscheduled cesarean delivery. We noted a 4.3-min increase in operative time for total salpingectomy after multivariate analysis (p<.01). ConclusionAt maternal request for postpartum permanent contraception during cesarean delivery, bilateral total salpingectomy can be a safe and feasible method even in case of unscheduled cesarean delivery. Implications statementOur results suggest that bilateral total salpingectomy during any cesarean delivery may be an acceptable choice for its higher contraceptive efficacy and risk-reduction effect for ovarian cancer, at the price of a small increase in operative time.

Bilateral salpingectomy versus bilateral partial salpingectomy during cesarean delivery.

ObjectiveTo compare surgical outcomes in patients undergoing bilateral salpingectomy (salpingectomy group) with those who had partial salpingectomy (partial salpingectomy group) during cesarean delivery.Materials and methodsA chart review from July 2015 to November 2016 was performed. We included women who had sterilization during cesarean delivery. We excluded sterilization by occlusive methods. Our primary outcomes were total operative time and a composite score of transfusion rate, internal organ injury, hospital readmission, and endometritis. Secondary outcomes included menstrual abnormalities, pelvic pain, quality of life assessment, and regrets rate. We compared these outcomes between women in the salpingectomy and partial salpingectomy groups. Chi-squared, Fisher’s exact, t-test, and Mann–Whitney U were utilized for statistical analysis where appropriate. A P<0.05 was considered significant.ResultsWe included a total of 160 pregnancies. Of these, 41 were in the salpingectomy and 119 in the partial salpingectomy group. The median total operative time was longer for the salpingectomy group (62 [IQR 54, 71] vs 60 minutes [IQR 46, 72]; P=0.03). The composite of surgical complications (19.5% vs 12.6%; P=0.28) was not significantly different between our study groups. Menstrual irregularities (P≥0.99), quality of life (P≥0.99), dyspareunia (P≥0.99), dysmenorrhea (P=0.36), and regrets (P≥0.99) were not different between groups.ConclusionSalpingectomy during cesarean delivery increased the median operative time by 2 minutes and may not be associated with an increased risk of surgical complications. We acknowledge the need for larger multi-center trials to corroborate our outcomes.

Successful completion of total and partial salpingectomy at the time of cesarean delivery

ObjectiveEvaluate completion of partial or total salpingectomy during Cesarean delivery based on intended procedure. Study designWe conducted a retrospective study of women who had a permanent contraception procedure during Cesarean delivery at an urban, academic hospital from November 2015 through April 2017. We reviewed all charts of women who had a Cesarean delivery to identify those who underwent concomitant tubal surgery, including both completed and attempted procedures. We compared demographic, medical, and obstetric characteristics of participants by planned and completed method using univariate analysis. ResultsWe identified 122 women who underwent Cesarean delivery with planned concurrent permanent contraception procedure. Thirty-two (26.2%) women preferred partial salpingectomy and 90 (73.8%) preferred total salpingectomy. All women who desired partial salpingectomy had the procedure performed. However, 17 (18.9%) women desiring total salpingectomy could not have the procedure performed bilaterally: nine underwent a mixed procedure and seven underwent bilateral partial salpingectomy because of adhesions, engorged vasculature, or unspecified reasons. One woman had significant adhesive disease preventing any procedure. Among women who planned a total salpingectomy, having ≥3 Cesarean deliveries was the only factor associated with needing an alternative procedure (P=.04). ConclusionAs interest in total salpingectomy for permanent contraception increases, surgeons should counsel women who are interested in total salpingectomy at time of Cesarean delivery that adhesions and tubal proximity to adjacent vessels may preclude completion of bilateral tubal removal and discuss alternative options prior to surgery. ImplicationsInterest in bilateral total salpingectomy for permanent contraception at the time of Cesarean delivery is increasing; accordingly, surgeons should counsel patients that adhesions and proximity to large vessels may preclude completion of bilateral total salpingectomy, especially in women who have had multiple prior Cesarean deliveries.

Bilateral tubal ectopic gestation: A case report

Spontaneous bilateral tubal ectopic pregnancy is a rare occurrence. A case of a recently managed spontaneous bilateral tubal ectopic pregnancy is discussed. A 37-year-old grand multiparous farmer, who had been amenorrhoeic for 12 weeks, presented with lower abdominal pain, bleeding per vaginam, and dizziness. Other clinical and ultrasonographic findings were suggestive of ruptured ectopic gestation. Intra-operative findings included ruptured right tubal and unruptured left tubal ectopic pregnancies. Bilateral partial salpingectomy was performed with uneventful recovery. Intra-operative diagnosis of bilateral tubal ectopic pregnancy was confirmed by histology of the specimens.

Weight and body fat changes in postpartum depot-medroxyprogesterone acetate users

BackgroundAlthough postpartum depot-medroxyprogesterone acetate (DMPA) recipients often cite weight gain as the reason for discontinuing DMPA, little is known about body composition changes in postpartum DMPA recipients. Study designWomen who used DMPA during the postpartum year were measured on several anthropometric dimensions of body composition and compared with women who elected surgical sterilization with bilateral partial salpingectomy (BPS). ResultsAfter 1 year, DMPA recipients did not differ from the BPS group in weight or percent body fat changes. Almost half the women using DMPA returned to pregravid weight; nearly half gained weight. Higher pre-pregnancy body mass index was associated with weight gain among DMPA recipients. ConclusionsDMPA recipients who were overweight or obese before pregnancy may have greater risk for weight gain in the first year postpartum. However, when counseling women, the risk for DMPA-related weight gain should be balanced against the potential for increased weight from subsequent pregnancies.

Anesthesia for Partial Bilateral Salpingectomy in a Patient with Idiopathic Hypertrophic Cardiomyopathy. Case Report and Review of the Literature

Hypertrophic cardiomyopathy is a rare, autosomal dominant cardiac disorder characterized by hypertrophy of the interventricular septum and mitral valve abnormalities. A 25-year old female, second gestation, with a diagnosis of hypertrophic cardiomyopathy for four years and history of mild intermittent asthma controlled with sporadical use of corticosteroids. On physical exam, the patient had a IV/VI systolic and plurifocal heart murmur and accentuated scoliosis with palpable intervertebral spaces. She complained of occasional palpitations during pregnancy, and was treated with 100 mg of atenolol a day. Complete blood count, creatinine, and electrolytes were within normal limits; echocardiogram showed hypertrophic cardiomyopathy predominantly septal and ejection fraction of 0.76%. The patient underwent emergency labor giving birth to a live female fetus, Apgar 9/9, without maternal and fetal hemodynamic complications. The patient was scheduled for bilateral partial salpingectomy. During the interview, the patient refused general anesthesia for the procedure. A decision was made for combined regional blockade. The surgical procedure lasted 20 minutes during which changes in blood pressure and heart rate were up to 10% lower than baseline levels without immediate hemodynamic or surgical complications. Absolute maternal mortality in hypertrophic cardiomyopathy (HC) is very low and it is usually seen in patients with high risk factors. Evidence does not show an increased risk of regional blocks in females with HC when it is used for vaginal delivery. Both general anesthesia and regional blocks were successfully used without complication for cesarean sections in patients with HC.

Puerperal Febrile Morbidity Associated with the Reverse Transcriptase Inhibitor Stavudine

We report a case of postpartum drug fever associated with stavudine, a new reverse transcriptase inhibitor. A human immunodeficiency virus (HIV)-infected patient experienced fevers to 102.6°F following vaginal delivery and bilateral partial salpingectomy. When history, physical, laboratory, and radiographic evaluations did not reveal a source of infection, discontinuation of the stavudine led to rapid defervescence within 28 hours. Stavudine-associated fever may be a cause of puerperal febrile morbidity in the HIV-seropositive patient without a source of infection.

Necrotizing fasciitis of the total abdominal wall after sterilization by partial salpingectomy: Case report and review of literature

A case of necrotizing fasciitis with full-thickness loss of the entire abdominal wall is reported after an uncomplicated sterilization by bilateral partial salpingectomy through a minilaparotomy incision in a healthy young patient. Salvage was accomplished by early wide surgical debridement and multiple reconstructive procedures.

Retained penrose drain following cholecystectomy.

To the Editor.— Most authorities on biliary surgery recommend drainage following cholecystectomy, soft rubber Penrose drains preferred. These are advanced at intervals postoperatively until completely removed, usually between 7 and 14 days. Meanwhile, care is taken to prevent drain retraction back into the peritoneal cavity, and to avoid breaking the drains as they are advanced. Fortunately the retained Penrose drain following cholecystectomy is a rare complication. Report of a Case.— A 40-year-old obese multiparous woman underwent cholecystectomy, bilateral partial salpingectomy, and umbilical hernioplasty. Prior to wound closure, two small (1.27 cm) Penrose drains were placed adjacent to the bed of gallbladder and foramen of Winslow, respectively, and then drawn through a lateral stab incision, just below the 12th rib. On the second postoperative day during the first attempt to advance the drains they broke, leaving most of the drain intraperitoneally (Figure). An immediate, but unsuccessful attempt failed to retrieve the

PATIENT REACTION TO PUERPERAL SURGICAL STERILIZATION I. GENERAL CONSIDERATIONS

Abstract The present paper initiates a survey of the psychosexual-sociologie reaction of the surgically sterilized woman. The survey was carried out by individual interview conducted in the patient's home by a woman trained in social work and experienced in marriage counseling. The present report deals chiefly with the composition of the patient group studied and the superficial reaction to the procedure expressed in terms of having “regretted” or “not regretted” the loss of the ability to bear children. In general, the women who were persuaded to undergo the procedure by the physician expressed more regret than did those who themselves requested the operation. Over 90 per cent of the patients who suggested the procedure themselves expressed no subsequent regret. Also, the patients whose primary indication for sterilization was organic disease or previous cesarean section indicated more regret than did those whose principal indication was a high degree of parity. Sixty-four per cent of the women who expressed subsequent regret over being sterilized had had multiple cesarean sections as the principal indication for the procedure. While no final conclusions can be reached from this particular study, it appears that the women who themselves suggest bilateral partial salpingectomy on the basis of their high parity are the women who in retrospect are the least likely to experience regret over the procedure.

Patient reaction to puerperal surgical sterilization: I. General considerations

The present paper initiates a survey of the psychosexual-sociologie reaction of the surgically sterilized woman. The survey was carried out by individual interview conducted in the patient's home by a woman trained in social work and experienced in marriage counseling. The present report deals chiefly with the composition of the patient group studied and the superficial reaction to the procedure expressed in terms of having “regretted” or “not regretted” the loss of the ability to bear children.In general, the women who were persuaded to undergo the procedure by the physician expressed more regret than did those who themselves requested the operation. Over 90 per cent of the patients who suggested the procedure themselves expressed no subsequent regret. Also, the patients whose primary indication for sterilization was organic disease or previous cesarean section indicated more regret than did those whose principal indication was a high degree of parity. Sixty-four per cent of the women who expressed subsequent regret over being sterilized had had multiple cesarean sections as the principal indication for the procedure. While no final conclusions can be reached from this particular study, it appears that the women who themselves suggest bilateral partial salpingectomy on the basis of their high parity are the women who in retrospect are the least likely to experience regret over the procedure.