Definition & Overview
Salpingectomy is the process of surgically removing one or both of the fallopian tubes while leaving the uterus and ovaries intact. The procedure was developed primarily to address ectopic pregnancy but is also indicated for other diseases or conditions of the female reproductive system.
The fallopian tube, also called the uterine tube, is where the sperm cells travel to fertilize the egg. It also provides an optimal environment for fertilization and transports the egg from the ovary to the uterus. In a normal female reproductive system, there are two fallopian tubes which ends are located near the ovaries to catch and transport the eggs. During ectopic pregnancy, the fertilized egg is not transported into the uterus and stays inside the fallopian tube.
In most cases, a unilateral salpingectomy is performed where only one of the two fallopian tubes is removed. This leaves the patient with the capability to still conceive and reproduce. On the other hand, removing both fallopian tubes is referred to as bilateral salpingectomy and is only considered in extreme cases.
Who Should Undergo and Expected Results
The most common indication for salpingectomy is an ectopic pregnancy, where there is a very low possibility for the fertilized egg to survive. Physicians usually advise to terminate the pregnancy as soon as this condition is diagnosed, as it can be life-threatening to the patient.
This procedure is also considered for those who are diagnosed with salpingitis or infection of the fallopian tube. The affected part is usually inflamed and develops scar tissue, which may block the egg as it is transported to the uterus and this contributes to the occurrence of ectopic pregnancy. Inflammation is often caused by sexually transmitted diseases or infection following childbirth or abortion. There are also cases in which the fallopian tubes become distally blocked and are filled with fluid. This condition is termed hydrosalpinx and can be treated with salpingectomy.
In some cases, the insertion of intrauterine devices can cause damage to the fallopian tube. The patient may need to undergo salpingectomy to treat this condition and prevent further injury.
Salpingectomy is also considered as a patient undergoes hysterectomy or the removal of the uterus due to disease. Patients who are predisposed to ovarian cancer may be advised to try salpingectomy as means of prevention.
Women who want to achieve effective contraception may be offered bilateral salpingectomy. However, this requires careful consideration, as the result of the procedure is permanent and irreversible.
The success of the procedure largely depends on its purpose. For addressing ectopic pregnancy or treating salpingitis, the outcomes are generally successful with no complications and patients are able to conceive afterwards. Patients often recover quickly, especially after undergoing a rehabilitation program to reduce postoperative pain and encourage healing. Rest period for several days to weeks is required, depending on the severity of their condition.
For those diagnosed with diseases that affect other parts of the female reproductive system such as the uterus and ovaries, salpingectomy may be just one of the steps needed to achieve treatment. Patients may need to undergo additional procedures to effectively manage their conditions.
How is the Procedure Performed?
There are several techniques to perform salpingectomy, but the most common and preferred method is laparoscopy. The surgeon makes a small incision in the abdomen area, usually near the navel. A laparoscope, an instrument resembling a small telescope, is inserted and the surgeon identifies the tube to be removed. Another probe is inserted through a second incision near the pubic area to assist in viewing the surgical site. The affected fallopian tube is clamped and cauterized. The tube is then transected or cut from the rest of the nearby reproductive parts. The underlying mesosalpinx is then sutured and abdomen incision closed.
Some surgeons prefer to do away with a viewing instrument and would make an incision in the lower abdomen to remove the tube instead. This process is termed minilaparotomy.
A more invasive approach is termed laparotomy and requires the surgeon to make a large incision in the lower abdomen to allow a better exploration of the abdomen area. This approach is especially considered if there is a need to remove both fallopian tubes.
In rare cases, salpingectomy is performed through a surgical incision in the vagina, termed colpotomy. In this method, the affected fallopian tube is approached through the vagina.
Possible Risks and Complications
Salpingectomy carries the associated risk of adverse reaction to anesthesia, similar to other surgical procedures. Excessive bleeding is another risk, which is possible during and after the procedure.
There is also the possibility of damaging surrounding parts like the uterus, ovaries, blood vessels, and nerves. In rare cases, the bowels may also be injured or damaged, resulting in the need for additional surgical interventions. Another possible complication is intestinal blockage, leading to stomach cramps, bloating, and repeated burping.
Pain in the surgical site is also expected, though it is usually manageable and disappears after a few weeks. Scar formation is expected, both internally and externally.
Johnson N, van Voorst S, Sowter MC, Strandell A, Mol BW. Surgical treatment for tubal disease in women due to undergo in vitro fertilisation. Cochrane Database Syst Rev. 2010. (1):CD002125.
Audebert A, Pouly JL, Bonifacie B, et al. Laparoscopic surgery for distal tubal occlusions: lessons learned from a histor