Opportunistic Salpingectomy Research Articles

Cost-Effectiveness of Risk-Reducing Surgery for Breast and Ovarian Cancer Prevention: A Systematic Review.

Policymakers require robust cost-effectiveness evidence of risk-reducing-surgery (RRS) for decision making on resource allocation for breast cancer (BC)/ovarian cancer (OC)/endometrial cancer (EC) prevention. We aimed to summarise published data on the cost-effectiveness of risk-reducing mastectomy (RRM)/risk-reducing salpingo-oophorectomy (RRSO)/risk-reducing early salpingectomy and delayed oophorectomy (RRESDO) for BC/OC prevention in intermediate/high-risk populations; hysterectomy and bilateral salpingo-oophorectomy (BSO) in Lynch syndrome women; and opportunistic bilateral salpingectomy (OBS) for OC prevention in baseline-risk populations. Major databases were searched until December 2021 following a prospective protocol (PROSPERO-CRD42022338008). Data were qualitatively synthesised following a PICO framework. Twenty two studies were included, with a reporting quality varying from 53.6% to 82.1% of the items scored in the CHEERS checklist. The incremental cost-effectiveness ratio/incremental cost-utility ratio and cost thresholds were inflated and converted to US$2020, using the original currency consumer price index (CPI) and purchasing power parities (PPP), for comparison. Eight studies concluded that RRM and/or RRSO were cost-effective compared to surveillance/no surgery for BRCA1/2, while RRESDO was cost-effective compared to RRSO in one study. Three studies found that hysterectomy with BSO was cost-effective compared to surveillance in Lynch syndrome women. Two studies showed that RRSO was also cost-effective at ≥4%/≥5% lifetime OC risk for pre-/post-menopausal women, respectively. Seven studies demonstrated the cost-effectiveness of OBS at hysterectomy (n = 4), laparoscopic sterilisation (n = 4) or caesarean section (n = 2). This systematic review confirms that RRS is cost-effective, while the results are context-specific, given the diversity in the target populations, health systems and model assumptions, and sensitive to the disutility, age and uptake rates associated with RRS. Additionally, RRESDO/OBS were sensitive to the uncertainty concerning the effect sizes in terms of the OC-risk reduction and long-term health impact. Our findings are relevant for policymakers/service providers and the design of future research studies.

Opportunistic Salpingectomy for the Primary Prevention of Ovarian Cancer.

Opportunistic Salpingectomy for the Primary Prevention of Ovarian Cancer.

8189 “Failed CS-BS” a Role for vNOTES in Patient with 4 Prior Cesarean Sections and Severe Adhesive Disease Desiring Sterilization

Study Objective To demonstrate the utility of vNOTES for opportunistic bilateral salpingectomy for permanent sterilization after failed attempt at bilateral tubal ligation at the time of previous Cesarean section. Design Stepwise demonstration with narrated video footage. Setting vNOTES opportunistic bilateral salpingectomy for permanent sterilization after failed bilateral tubal ligation during previous Cesarean section. Patients or Participants 31-yo G4P3013 with 4 prior Cesarean sections desiring permanent sterilization, BMI 38. Interventions During previous Cesarean section, bilateral adnexa unable to be accessed due to dense adhesions from previous surgeries. Patient to have vNOTES instead of conventional laparoscopy. Measurements and Main Results Patient underwent a successful vNOTES bilateral salpingectomy, with pathology confirming bilateral fallopian tubes. Conclusion vNOTES bilateral salpingectomy is a reasonable alternative to conventional laparoscopy in patients with severe adhesive disease. To demonstrate the utility of vNOTES for opportunistic bilateral salpingectomy for permanent sterilization after failed attempt at bilateral tubal ligation at the time of previous Cesarean section. Stepwise demonstration with narrated video footage. vNOTES opportunistic bilateral salpingectomy for permanent sterilization after failed bilateral tubal ligation during previous Cesarean section. 31-yo G4P3013 with 4 prior Cesarean sections desiring permanent sterilization, BMI 38. During previous Cesarean section, bilateral adnexa unable to be accessed due to dense adhesions from previous surgeries. Patient to have vNOTES instead of conventional laparoscopy. Patient underwent a successful vNOTES bilateral salpingectomy, with pathology confirming bilateral fallopian tubes. vNOTES bilateral salpingectomy is a reasonable alternative to conventional laparoscopy in patients with severe adhesive disease.

A Study to Evaluate the Effect of Opportunistic Salpingectomy on Ovarian Reserve and Function.

There are conflicting reports on status of ovarian function after hysterectomy and opportunistic salpingectomy in premenopausal women. The present study was undertaken to understand the effect of salpingectomy done at the time of hysterectomy on ovarian reserve and function as measured by serum AMH and FSH levels before and after the surgery. This was a prospective study conducted on 60 women who underwent hysterectomy at our tertiary care centre, Shri Guru Ram Rai Institute of medical and health sciences, Dehradun, from January 2020 to September 2021. Serum AMH and FSH levels were monitored preoperatively and 3months postoperatively in patients undergoing hysterectomy with bilateral salpingectomy and hysterectomy without salpingectomy. The mean age of the patients was 41.83 yrs in group 1 and 43.73 yrs in group 2 [p value = 0.078]. Most common indication of hysterectomy was AUB-L in both the groups (86% and 80%, respectively). Mean operative time was 115.50min in group 1 and 114.40min in group 2 [p value = 0.823]. Mean intra-operative blood loss was 214ml in group 1 and 199.33ml in group 2 [p value = 0.087]. Serum AMH and FSH were insignificantly decreased in both the groups post-operatively after 3months, and the difference between both groups was also not statistically significant. Salpingectomy done at the time of hysterectomy for benign indications with preservation of ovaries did not have any short-term adverse effects on ovarian reserve and function.

Possible Association of Hysterectomy Accompanied with Opportunistic Salpingectomy with Early Menopause: A Retrospective Cohort Study.

Opportunistic salpingectomies (OSs) are concurrently performed with hysterectomies to prevent epithelial ovarian cancer. This study aimed to investigate the correlation between OS and early menopause in females who have undergone hysterectomies. This was a retrospective cohort study involving 79 females who had undergone a hysterectomy, with or without an OS, between January 2007 and December 2015. Their ages at surgery, at menopause, and the lengths of time from surgery to menopause were compared. An OS had been performed in 54 and not performed in 25 of the enrolled patients, comprising the OS and non-OS groups. Body mass index was significantly higher in the OS group (OS: 25.27 ± 4.17 vs. non-OS: 22.97 ± 3.27, p = 0.01). Additionally, menopausal sleep problems were more prevalent in the OS group than in the non-OS group (41% vs. 12%, p = 0.01). Notably, the time from surgery to menopause was significantly shorter in the OS group than in the non-OS group (OS: 1.84 ± 1.85 vs. non-OS: 2.93 ± 2.43, p = 0.031). After adjusting the covariates, the OS group was associated with a significantly shorter period between surgery and menopause (p = 0.029). In conclusion, these results showed that a hysterectomy plus an OS might cause earlier menopause than a hysterectomy only. An OS should be preoperatively discussed with patients regarding the possibility of early menopause. The findings of this study require further large-scale investigations to reinforce the results.

Prevalence of Serous Tubal Intraepithelial Carcinoma (STIC) at the Time of Postpartum Contraceptive Procedures during Caesarean Delivery

Background: To assess the prevalence of serous tubal intraepithelial carcinoma (STIC) in women underwent opportunistic salpingectomy at the time of caesarean delivery (CD). Methods: We conducted a retrospective cohort study (2014–2017) of women who received either bilateral total or partial salpingectomy as postpartum permanent contraception procedure during CD. We collected the characteristics of the patients, the type of CD (elective versus unscheduled), the type of surgical procedure and the related complications. We analysed surgical outcomes and calculated the point prevalence of STIC. Results: We enrolled 280 patients. Of these, 107 (38.2%) and 173 (61.8%) underwent respectively total and partial bilateral salpingectomy. Majority of CDs were elective (81.8%); we did not find differences for intra- and post-operative surgical procedure-related complications. Bilateral fimbriated-part of the tube was available for analysis in 245 patients and STIC was identified in only one patient (prevalence of 0.4%). Conclusions: The frequency of STIC in patients undergoing partial or total bilateral salpingectomy during CD is extremely low, less than 1%. Total bilateral salpingectomy can be proposed as post-partum permanent contraception procedure without increasing surgical related complications. Further randomised studies are needed to confirm the benefits and safety of this procedure.

Ovarian Function in Patients Who Underwent Opportunistic Bilateral Salpingectomy during Hysterectomy

Objective(s): To provide additional data and to inform all women at average risk of ovarina cancer, undergoing a benign gynecological laparoscopic procedure about the Pro’s and the Con’s of opportunistic bilateral salpingectomy (OBS). Mechanism: Risk reducing salpingo-oophorectomy to prevent epithelial ovarian cancer (EOC) is associated with decreased quality of life and increased overall mortality. OBS has emerged as a primary prevention of ovarian cancer through a paradigm shift in which fallopian tubes are often the cause of ovarian cancer rather than the ovaries themselves. Findings in Brief: Causal relationship of salpingectomy and reduced risk of ovarian cancer has not been proven yet. There are several population-based studies that showed bilateral salpingectomy reduced risk of EOC by 42–67%, but there also is a study that suggest increased risk of ovarian cancer after salpingectomy. As for risk of surgical complications, several cohort studies have demonstrated that there was no increase in rates of hospital readmission, blood transfusion, day of hospital stay. However, recent meta-analysis stated that there were insufficient data to assess any difference in both intraoperative and postoperative complication rates. The procedure of salpingectomy can disrupt blood supply to the ovary. Data of reproductive outcome after assisted reproductive technologies such as in vitro fertilization and embryo transfer (IVF-ET) are conflicting. Some studies suggest that salpingectomy did not compromise the outcome of IVF-ET, but other studies found that salpingectomy may lead to decreased ovarian reserve after salpingectomy. For patients who do not wish fertility, data on the effect of OBS during hysterectomy suggest that changes in serum ovarian reserve markers were not different between OBS group and control group. Conclusions: Bilateral salpingectomy should be considered at the time of abdominal or pelvic for women at average risk of ovarian cancer. However, physicians should discuss the protective benefit of bilateral salpingectomy against ovarian cancer and controversial data on ovarian reserve.

Efficiency of treatment and diagnostic algorithms in the rehabilitation program of women after hysterectomy with opportunist salpingectomy due to uterine myoma

Objectives: to determine the effectiveness of the rehabilitation program in women of reproductive age with uterine fibroids for correction of genitourinary syndrome after hysterectomy with opportunistic salpingectomy.Materials and methods. 160 women were examined after hysterectomy with fallopian tubes. State of the urogenital tract and urogenital dysfunction researched with the using the POP-Q system, the Barlow scale, vaginoscopy. Also it was used evaluation of the vaginal pH and mucosal microbiota state, assessment of the vaginal health index according to G. Bochmann, assessment of the impact of vulvovaginal symptoms on the life’s quality with the MOS SF-36 questionnaire in the dynamics of the postoperative period. The treatment algorithm included local preparations of hyaluronic acid, lactobacillus preparations in combination with vitamin D solution, in case of a severe course – topical estrogens, in case of vasomotor symptoms – estradiol 50 μg/day and vitamin D 4000 IU daily or 20,000 IU once a week.Results. Manifestations of genitourinary syndrome were revealed 1 year after surgery, namely: hypotrophy of the vaginal mucous membrane in 36.3% of women, urinary incontinence in almost a third of patients, prolapse of the vaginal walls of the I–II degree in 8.8% of women, a pathological microscopic picture in 68.1% of female. The proposed algorithms in the rehabilitation program made it possible to eliminate or reduce the severity of genitourinary symptoms 5 years after hysterectomy, in particular, to reduce the frequency of vulvovaginal atrophy by 25%, to normalize the biocenosis and pH of the vaginal contents, to reduce the clinical manifestations of urination disorders (pollakiuria and nocturia by 14% and 12,8%, respectively), feeling of incomplete emptying of the bladder by 12.9%, stress urinary incontinence by 17.9%, vaginal prolapse by 13.3% compared to the group with standard postoperative management.Conclusions. Hysterectomy with opportunistic salpingectomy for uterine fibroids has a positive effect on the life’s quality of patients by improving the physical comfort due to the reduction of clinical symptoms of uterine fibroids. However, changes in the quality of life after surgical intervention associated with disturbances in the psycho-emotional sphere were recorded in 49.4% of women, including those provoked by the manifestation of genitourinary syndrome in 19.3%. The proposed algorithm in the rehabilitation program made it possible to reduces the severity of genitourinary symptoms.

Utility of Vaginal Natural Orifice Transluminal Endoscopic Surgery for Permanent Sterilization after Failed Attempt at Bilateral Tubal Ligation at the Time of Previous Cesarean Section

To demonstrate the utility of vaginal natural orifice transluminal endoscopic surgery (vNOTES) for opportunistic bilateral salpingectomy for permanent sterilization after a failed attempt at bilateral tubal ligation at the time of previous cesarean section. Stepwise demonstration with narrated video footage. There is evidence to support the statistically significant superiority of vNOTES compared with conventional laparoscopy (CL) in terms of patient satisfaction, postoperative pain, time to recovery, and cosmetic results in bilateral salpingectomies for permanent sterilization [1]. Limited studies demonstrate the ease and safety of access to the abdominal cavity in vNOTES while avoiding passage through the abdominal wall, port site complications (infection, hernia, etc.), and those associated with peritoneal adhesions during abdominal laparoscopy or laparotomy [2]. To the best of our knowledge, this would be the first published video of a vNOTES bilateral salpingectomy performed specifically in a patient whose previously attempted bilateral tubal ligation was unsuccessful owing to adhesive disease from 4 previous cesarean sections. Institutional review board approval was not required. We describe a case of a 31-year-old female, with a history of 4 previous cesarean deliveries and a cholecystectomy, who desired permanent sterilization 3 months after the previous cesarean section. During previous cesarean section, bilateral adnexa were unable to be accessed owing to dense adhesions from previous surgeries. The patient was counseled on various forms of reversible contraceptive methods; however, she desired permanent sterilization with a surgical procedure. She was counseled on the various routes for opportunistic salpingectomy. Risks, benefits, and alternatives of each surgical approach were discussed. The patient consented for vNOTES opportunistic salpingectomy and possible CL. She was aware that she had significant adhesive disease at the time of previous cesarean section, so may potentially require a laparotomy for the procedure. However, she refused a laparotomy if the surgery was unable to be performed minimally invasively. (1) Demonstrate setup of transvaginal access platform for vNOTES bilateral salpingectomy. (2) Abdominal survey and appreciation of severe adhesive disease through posterior cul-de-sac. (3) Bilateral salpingectomy through single-site vaginal natural orifice surgery. vNOTES bilateral salpingectomy can be considered as a reasonable alternative to CL in patients with severe abdominal adhesive disease from previous surgeries.

Effect of hysterectomy on the function of saved ovaries and correction of hormonal imbalance

The objective: to assess the hormonal disorders in patients after the radical treatment for leiomyoma and to develop the therapeutic options for correction.Materials and methods. The clinical and laboratory assessment of postoperative course after leiomyoma surgery in 160 women of reproductive age was carried out. The following groups of patients were formed: I group – 90 patients after vaginal hysterectomy (HE) with opportunistic salpingectomy and ovarian preservation, II group – 70 patients after abdominal HE with opportunistic salpingectomy and ovarian preservation. The control group included 50 women of reproductive age with asymptomatic leiomyoma.Then the following groups were formed to assess the effectiveness of the proposed medical correction program: the main group – 46 patients after vaginal HE with fallopian tubes and 36 persons after abdominal HE with fallopian tubes – received the proposed medical correction program, and the comparison group – 44 and 34 individuals after vaginal and abdominal HE with opportunistic salpingectomy and ovarian preservation, respectively, with standard approach for postoperative and rehabilitative periods.The diagnostic program included the assessment of hormonal level, post-hysterectomy syndrome degree by modified menopausal index using survey, urogenital and sexual dysfunction, and the indicators of vulvovaginal atrophy according to the Barlow scale.Results. Neurovegetative symptoms were observed in 36,7 % patients in the I group and 48.6 % - II group, vegetative-vascular symptoms – 46.7 % and 62.3 %, respectively. Insomnia was characterized by the sleep process disorders, the preservation of the feeling of fatigue after waking up. It is necessary to mention that an increase in the proportion of cardiovascular diseases up to 36 months after surgery (hypertension, dyshormonal cardiomyopathy and their combinations, 23.1 % were diagnosed with dyshormonal mastopathy, the women complained on arthralgia, morning joint stiffness, ostealgia twice more.The assessment of sexual disorders and manifestations of urogenital tract dysfunction allowed to indicate the most significant rate of dysuria complains in 72.9 % of cases in the II group after classical abdominal HE. Up to 36 months after surgery the subclinical hypothyroidism was found in 62.2 % of women in the I group and 31.4 % – II group, clinically significant hypothyroidism – in 21.1 % and 55.7 %, respectively.In the half of the cases the hormonal imbalance like hypoesrogenia was determined up to 36 months of monitoring without statistically significant differences between groups of different HE methodic. The main factor was patient’s age in which endocrine, vegetative-vascular disorders and the clinical manifestations of psychosomatic are developed in a larger percentage of significantly earlier in women of late reproductive age.The use of proposed program of therapeutic options after HE with ovarian preservation allowed to provide a tendency of the estradiol, progesterone and testosterone levels normalization, prolactin and cortisol concentrations were close to the reference values. Estradiol concentration in the women in main group increased, although it remained significantly below the age normal indices, and the most significant normalization of theses parameters were determined in women who received hormonal replacement therapy. Clinically positive effect in patients on the severity of neurovegetative and psychoemotional manifestations on the background of differentiated treatment was observed after 3 months from the beginning of therapy.Conclusions. The obtained results suggest that the optimization of the treatment program with the the proposed drugs in women in the groups leads to relative optimization of hormonal status and initiation of compensatory-adaptive responses of the organism, which improves the quality of life and eliminates symptoms of hypoestrogenism.

EFFECT OF HYSTERECTOMY WITH OPPORTUNISTIC SALPINGECTOMY FOR UTERINE FIBROIDS ON THE DEVELOPMENT OF METABOLIC SYNDROME AND WAYS OF ITS REDUCTION

The aim of the study – to determine the effect of hysterectomy with opportunistic salpingectomy for uterine fibroids on the manifestation and progression of metabolic syndrome and to develop ways of reducing the identified changes. Materials and Methods. A comprehensive clinical and laboratory evaluation of the influence of hysterectomy with opportunistic salpingectomy for uterine fibroids on the development of metabolic syndrome was performed in the Gynecological Department of Municipal Non-Profit Enterprise “Kyiv Perinatal Center”. 160 women were included in the study: 90 patients underwent vaginal hysterectomy including fallopian tubes (both classical and associated with laparoscopy), and 70 women underwent abdominal hysterectomy including fallopian tubes. Results and Discussion. The development and progression of hypoestrogenemia after hysterectomy with opportunistic salpingectomy contributes to the loss of cardioprotective effects of estrogen, accompanied by psychoemotional and vegetative-vascular dystonia in the early postoperative period of mild and moderate degree, mostly in women under 45 years (30.63 % and 71.86 %, respectively), while metabolic and endocrine abnormalities are practically absent. At the same time, 12 months after surgery, 56.9 % of patients undergo gradual formation of the main components of the metabolic syndrome – hyperglycemia, insulin resistance, dyslipidemia, increasing parameters of atherogenic lipid fractions, increased BMI and vegetative dystonia of the hypertensive type. Conclusions. The use of metabolic therapy in the remote postoperative period allowed to control blood pressure and improve the clinical and laboratory parameters, namely reducing the level of atherogenicity index by 1.3 times (p<0.05), glycated hemoglobin, OGTT, HOMA index – by 0.8 times against baseline before treatment, which was accompanied by improvement of psycho-emotional and vegetative-vascular manifestations.

Cost-Effectiveness of Opportunistic Salpingectomy Following Vaginal Delivery for Ovarian Cancer Prevention [A102

INTRODUCTION: Opportunistic salpingectomy at the time of benign gynecologic surgery and cesarean delivery is a cost-effective strategy for ovarian cancer risk reduction. We sought to evaluate the cost-effectiveness of opportunistic salpingectomy compared to standard tubal ligation in the immediate postpartum period following vaginal deliveries. METHODS: Using two decision analytic models, we simulated a hypothetical cohort of 10,000 women undergoing bilateral salpingectomy or tubal ligation immediately following vaginal delivery. We derived probabilities of ovarian cancer risk reduction following tubal sterilization from published literature. We used institutional charge data to determine cost inputs. The primary outcome was the incremental cost-effectiveness ratio (ICER) per quality-adjusted life year (QALY) at a cost-effectiveness threshold of $100,000/QALY. Institutional review board (IRB) approval was obtained. RESULTS: Opportunistic salpingectomy is more cost-effective than tubal ligation following vaginal delivery in a theoretical cohort, with an ICER of $24,176/QALY. Compared to tubal ligation, opportunistic salpingectomy yields a theoretical total cost savings of $6.48 million. Discounted costs of ovarian cancer were $2.9 million lower for the salpingectomy cohort compared to tubal ligation. Opportunistic salpingectomy avoided 12 fewer ovarian cancer cases and 8 fewer ovarian cancer deaths compared to tubal ligation. CONCLUSION: Our analytic model demonstrates that following vaginal delivery, opportunistic salpingectomy is a cost-effective strategy for reducing risk of ovarian cancer. Compared to tubal ligation, opportunistic salpingectomy reduces ovarian cancer cases and mortality.

Racial and ethnic differences in the adoption of opportunistic salpingectomy for ovarian cancer prevention in the United States

Clinicians in the United States have rapidly adopted opportunistic salpingectomy for ovarian cancer prevention. However, little is known about racial and ethnic differences in opportunistic salpingectomy adoption. Surgical innovations in gynecology may be adopted differentially across racial and ethnic groups, exacerbating current disparities in quality of care. This study aimed to evaluate racial and ethnic differences in opportunistic salpingectomy adoption across inpatient and outpatient settings and assess the effect of national guidelines supporting opportunistic salpingectomy use on these differences. A sample of 650,905 women aged 18 to 50 years undergoing hysterectomy with ovarian conservation or surgical sterilization from 2011 to 2018 was identified using the Premier Healthcare Database, an all-payer hospital administrative database, including more than 700 hospitals across the United States. The association between race and ethnicity and opportunistic salpingectomy use was examined using multivariable-adjusted mixed-effects log-binomial regression models accounting for hospital-level clustering. Models included race and ethnicity by year of surgery (2011-2013 [before guideline] and 2014-2018 [after guideline]) interaction term to test whether racial and ethnic differences in opportunistic salpingectomy adoption changed with the release of national guidelines supporting opportunistic salpingectomy use. From 2011 to 2018, 82,792 women underwent hysterectomy and opportunistic salpingectomy (non-Hispanic White, 60.3%; non-Hispanic Black, 18.8%; Hispanic, 12.2%; non-Hispanic other race, 8.7%) and 23,398 women underwent opportunistic salpingectomy for sterilization (non-Hispanic White, 64.7%; non-Hispanic Black, 10.8%; Hispanic, 16.7%; non-Hispanic other race, 7.8%). The proportion of hysterectomy procedures involving an opportunistic salpingectomy increased from 6.3% in 2011 to 59.7% in 2018 (9.5-fold increase), and the proportion of sterilization procedures involving an opportunistic salpingectomy increased from 0.7% in 2011 to 19.4% in 2018 (27.7-fold increase). In multivariable-adjusted models, non-Hispanic Black (risk ratio, 0.94; 95% confidence interval, 0.92-0.97), Hispanic (risk ratio, 0.98; 95% confidence interval, 0.95-1.00), and non-Hispanic other race women (risk ratio, 0.93; 95% confidence interval, 0.90-0.96) were less likely to undergo hysterectomy and opportunistic salpingectomy than non-Hispanic White women. A significant interaction between race and ethnicity and year of surgery was noted in non-Hispanic Black compared with non-Hispanic White women (P<.001), with a reduction in differences in hysterectomy and opportunistic salpingectomy use after national guideline release (risk ratio2011-2013, 0.80 [95% confidence interval, 0.73-0.88]; risk ratio2014-2018, 0.98 [95% confidence interval, 0.95-1.01]). Moreover, non-Hispanic Black women were less likely to undergo an opportunistic salpingectomy for sterilization than non-Hispanic White women (risk ratio, 0.91; 95% confidence interval, 0.88-0.95), with no difference by year of surgery (P=.62). Stratified analyses by hysterectomy route and age at surgery revealed similar results. Although opportunistic salpingectomy for ovarian cancer prevention has been rapidly adopted in the United States, our findings suggested that its adoption has not been equitable across racial and ethnic groups. Non-Hispanic Black, Hispanic, and non-Hispanic other race women were less likely to undergo opportunistic salpingectomy than non-Hispanic White women even after adjusting for sociodemographic, clinical, procedural, hospital, and provider characteristics. These differences persisted after the release of national guidelines supporting opportunistic salpingectomy use. Future research should focus on understanding the reasons for these differences to inform interventions that promote equity in opportunistic salpingectomy use.

Effect of hysterectomy with opportunistic salpingectomy for uterine fibroids on the development of genitourinary syndrome and ways of its reduction

The article presents the assessment and analysis of the most important predictors and manifestations of genitourinary disorders in women of reproductive age after radical surgical treatment for uterine fibroids in the remote postoperative period. Ways of reducing the severity of symptoms are offered.&#x0D; The aim of the study – to establish the influence of hysterectomy with opportunistic salpingectomy for uterine fibroids on manifestation and progression of genitourinary syndrome and ways of the reduction in its severity.&#x0D; Materials and methods. Comprehensive clinical and laboratory assessment of the impact of hysterectomy with opportunistic salpingectomy for uterine fibroids on the development of metabolic syndrome was conducted at the gynecological department of the “Kyiv Perinatal Center”. The study included 160 women: 90 patients underwent vaginal classical and laporoscopic hysterectomy including fallopian tubes removal; and 70 patients underwent abdominal hysterectomy including fallopian tubes removal. Data on the assessment of pelvic floor condition and urogenital dysfunction were provided using a standardized POP-Q system, both at the stage of preoperative observation and for 1, 3 and 5 years after the surgery.&#x0D; Research results and their discussion. The most important risk factors that allow forming groups of patients requiring individualized approach in the choice of surgical techniques and rehabilitation program were pointed out. The obtained results allowed to isolate UCDT markers in fractions above 20%. 19 women (11.86%) underwent ovarian surgeries and used gonadotropin-releasing hormone agonists. Genitourinary and sexual disorders were diagnosed in 27 cases (19.3%) 12 months after surgery. Vaginoscopy, performed 12 months after surgery, revealed atrophic vaginitis in 58 cases (36.25%) without significant difference in groups. Microscopy of urogenital smears was in norm only in 51 patients (31.86%). Complaints of dysuria were most common among patients (59 – 36.85%). The combination of sexual disorders and other manifestations (flatulence and intestinal discomfort, stool problems, vaginal microbiota disorders, pelvic floor descent, etc.) was revealed in a quarter of women (28 – 17.50%), and more often – after vaginal hysterectomy (17 – 18.89%). Clinical symptoms of urinary incontinence were observed against the background of a negative cough test in almost a third of patients (49 – 30.63%). They were combined with pollakiuria, nocturia, and imperative urgency, exacerbated by alcohol and accompanied by cystalgia and genital prolapse. The use of low doses of estradiol in the rehabilitation program improved the clinical and laboratory parameters of the urogenital tract, reducing the incidence of vulvovaginal atrophy by 13%, normalizing the biocenosis and vaginal pH, reducing clinical manifestations of urinary incontinence (pollakiuria and nocturnal pollakiuria) by 14%, feeling of incomplete bladder emptying – by 15%, stress urinary incontinence – by 16%, vaginal prolapse – by 11%, compared to the group with standard postoperative management, as well as reducing the severity of psycho-emotional and vegetative-vascular manifestations.&#x0D; Conclusion. The expected effect of surgical recovery may be insufficient, and clinical symptoms of genitourinary syndrome may manifest in the postoperative period, which requires the development of clear algorithms for diagnosing urinary incontinence and pelvic floor failure in the preoperative stage and application of long-term preventive measures after hysterectomy in the remote postoperative period. There is no statistically significant difference in the development of genitourinary syndrome with different surgical approaches.

Genomic catastrophe, the peritoneal cavity and ovarian cancer prevention.

The current theory of carcinogenesis for the deadliest of 'ovarian' cancers-high-grade serous carcinoma (HGSC)-holds that the malignancy develops first in the fallopian tube and spreads to the ovaries, peritoneum, and/or regional lymph nodes. This is based primarily on the observation of early forms of serous neoplasia (serous tubal intraepithelial lesions [STILs], and serous tubal intraepithelial carcinomas [STICS]) in the fimbria of women undergoing risk reduction surgery. However, these lesions are uncommon in the general population, confer a low risk (5%) of HGSC following their removal in at-risk women with germ-line BRCA1/2 mutations, and require 4 or more years to recur as intraperitoneal HGSC. These features suggest that isolated STILs and STICs behave as precursors, with uncertain cancer risk rather than carcinomas. Their evolution to HGSC within, or after, escape from the tube could proceed stepwise with multiple biologic events; however, it is unclear whether tubal or ovarian HGSCs encountered in the setting of advanced disease evolved in the same fashion. The latter scenario could also be explained by a 'catastrophic' model in which STICs suddenly develop with invasive and metastatic potential, overwhelming or obscuring the site of origin. Moreover, a similar model might explain the sudden emergence of HGSC in the peritoneal cavity following escape of precursor cells years before. Long-term follow-up data from opportunistic or prophylactic salpingectomy should shed light on where malignant transformation occurs, as well as the timeline from precursor to metastatic HGSC. © 2022 The Pathological Society of Great Britain and Ireland.

Opportunistic salpingectomy between 2011 and 2016: a descriptive analysis.

Background:Opportunistic salpingectomy (OS) is the removal of fallopian tubes during hysterectomy for benign indications or instead of tubal ligation, for the purpose of preventing ovarian cancer. We determined rates of OS at the time of hysterectomy and tubal sterilization and examined how they changed over the study period.Methods:Using data from the Canadian Institute for Health Information’s Discharge Database and National Ambulatory Care Reporting System for all Canadian provinces and territories (except Quebec) between the fiscal years 2011 and 2016, we conducted a descriptive analysis of all patients aged 15 years or older who underwent hysterectomy or tubal sterilization. We excluded those with diagnostic codes for any gynecologic cancer and those who underwent unilateral salpingectomy. We examined the proportion who had OS during their hysterectomy and compared the proportion of tubal sterilizations that were OS with the proportion that were tubal ligations.Results:A total of 318 528 participants were included in the study (mean age 42.5 yr). The proportion of hysterectomies that included OS increased from 15.4% in 2011 to 35.5% by 2016. With respect to tubal sterilization, the rate of OS increased from 6.5% of all tubal sterilizations in 2011 to 22.0% in 2016. There was considerable variation across jurisdictions in 2016, with British Columbia having the highest rates (53.2% of all hysterectomies and 74.0% of tubal sterilizations involved OS).Interpretation:The rates of OS increased between 2011 and 2016, but there was considerable variation across the included jurisdictions. Our study indicates room for rates of OS to increase across many of the included jurisdictions.

Hysterectomy with opportunistic salpingectomy and its influence on structural-functional parameters of ovarian tissue

The study examined the development of posthysterectomy syndrome in patients after hysterectomy with preservation of ovarian tissue.&#x0D; The aim of the study was to assess the functionality of ovarian tissue in patients with hysterectomy and opportunistic salpingectomy performed for uterine fibroids.&#x0D; Materials and methods of the research. The study was performed in 160 women of reproductive age. The first group included 90 patients after vaginal hysterectomy with tubectomy and associated with laparoscopy, the second group - 70 patients after abdominal hysterectomy with tubectomy. The control group included 50 women of reproductive age 45.7±1.3 years with asymptomatic fibroids. The diagnostic algorithm included assessment of hormonal status and instrumental study of structural and functional parameters of ovarian tissue both at the stage of preoperative observation and for 12 months, 3 and 5 years after surgery.&#x0D; Research results and their discussion. At the preoperative stage in both groups found a higher percentage of thyroid disease, hypertension and metabolic disorders, as well as combined proliferative processes of the uterus. Normal ultrasound picture of the ovaries was found in 67.8 % - in the first group and in 47.1 % - in the second group. Significant increase in blood flow in the ovarian artery, in the remote period showing atrophic changes with the development of ovarian depletion syndrome. Assessment of hormonal status in both groups shows marked changes in baseline levels of gonadotropic hormones (FSH and LH): increase in baseline FSH levels by 2.2 times, LH - 1.5 times against the control group (p &lt;0.05), dyshormonal disorders persist for up to 5 years after surgery in one third of cases, and up to 36 months - there is an increase in the proportion of cystic and trophic changes, most pronounced in patients with reduced ovarian reserve, dysmetabolic manifestations and combined proliferative processes of the uterus and appendages before surgery, and syndrome chronic pelvic pain and venous pelvic blood supply in the postoperative period.&#x0D; Conclusions. The technique of performing a hysterectomy does not have a significant effect on the functional state of the ovaries in the long term. The main indicators of ovarian blood flow and steroid hormone production after hysterectomy with opportunistic salpingectomy for uterine fibroids are close to the reference values up to 36 months postoperatively

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.

Benefits and Risks of Bilateral Salpingectomy Compared With Standard Tubal Ligation During Cesarean Delivery for Permanent Postpartum Contraception.

Ovarian cancer is the second most common gynecologic malignancy, but the most deadly female reproductive cancer in the United States. Epithelial ovarian cancer makes up approximately 90% of all cases and is responsible for more than 90% of ovarian cancer deaths. Elective salpingectomy has been shown to reduce ovarian cancer risk when performed at the time of a benign hysterectomy. Data regarding the risks and benefits of opportunistic bilateral salpingectomy performed at the time of cesarean delivery are limited. We aim to review the current evidence regarding safety and benefits of opportunistic bilateral salpingectomy at the time of cesarean delivery compared with bilateral tubal ligation. Original research articles, review articles, and guidelines on contraception were reviewed. Opportunistic bilateral salpingectomy at the time of cesarean delivery is feasible and safe. Operative time may be increased up to 15 minutes for salpingectomy performed by suture ligation compared with standard tubal ligation. Women with a history of 3 or more cesarean deliveries are more likely to require an alternative procedure. It is important to counsel women that although opportunistic bilateral salpingectomy may significantly decrease the risk of ovarian cancer, it does not eliminate the risk entirely.

Outcomes From Opportunistic Salpingectomy for Ovarian Cancer Prevention

Opportunistic salpingectomy (OS), which is the removal of fallopian tubes during hysterectomy or instead of tubal ligation without removal of ovaries, is recommended to prevent ovarian cancer, particularly serous ovarian cancer. However, the effectiveness of OS is still undetermined. To examine observed vs expected rates of ovarian cancer among individuals who have undergone OS. This is a population-based, retrospective cohort study of all individuals in British Columbia, Canada, who underwent OS or a control surgery (hysterectomy alone or tubal ligation) between 2008 and 2017, with follow-up until December 31, 2017. Those with any gynecological cancer diagnosed before or within 6 months of their procedure were excluded. Data analysis was performed from April to August 2021. Removal of both fallopian tubes at the time of hysterectomy or instead of tubal ligation while leaving ovaries intact. An ovarian cancer diagnosis listed in the British Columbia Cancer Registry. Age-specific rates of epithelial and serous ovarian cancer in the control group were combined with the specific follow-up time in the OS group to calculate expected numbers (and 95% CIs) of ovarian cancers in the OS group. These were compared with observed numbers. Age-adjusted expected and observed numbers of breast and colorectal cancers were also examined in the OS group. There were 25 889 individuals who underwent OS (mean [SD] age, 40.2 [7.1] years; median [IQR] follow-up, 3.2 [1.6-5.1] years) and 32 080 who underwent hysterectomy alone or tubal ligation (mean [SD] age, 38.2 [7.9] years; median [IQR] follow-up, 7.3 [4.6-8.7] years). There were no serous ovarian cancers in the OS group and 5 or fewer epithelial ovarian cancers. The age-adjusted expected number was 5.27 (95% CI, 1.78-19.29) serous cancers and 8.68 (95% CI, 3.36-26.58) epithelial ovarian cancers. Age-adjusted expected vs observed numbers of breast cancers (22.1 expected vs 23 observed) and colorectal cancers (9.35 expected vs 8 observed) were not significantly different. In this cohort study, the OS group had significantly fewer serous and epithelial ovarian cancers than were expected according to the rate at which they arose in the control group. These findings suggest that OS is associated with reduced ovarian cancer risk.