Kartik K. Venkatesh, MD, PhD, fellow in the Division of Maternal-Fetal Medicine is lead author of the paper, “Cost-effectiveness of opportunistic salpingectomy vs tubal ligation at the time of cesarean delivery,” which was published in the January 2019 issue of the American Journal of Obstetrics and Gynecology. After strong evidence and major organizations recommending salpingectomy over tubal ligation, we sought to perform a systematic review and meta-analysis comparing the intraoperative attributes and complication rates associated with these 2 procedures. Overview. Until more data is available, Venkatesh recommends tubal ligation, and not salpingectomy, as the preferred approach for sterilization during cesarean delivery. Objective: Partial salpingectomy (e.g., Pomeroy technique (tubal ligation), and Parkland technique) Aetna considers the following (not an all-inclusive list) experimental and investigational for birth control and for all other indications because its safety and long-term effects have not been established: 1. hysteroscopic tubal sterilization/transcervical sterilization (e.g… This site needs JavaScript to work properly. We searched PubMed, the Cochrane Library, Embase, and clinical trials registries without time or language restrictions. Conclusions. Database searches revealed 74 potential studies, of which 11 were examined at the full-text level. Other UNC OB-GYN authors on the paper are Leslie Clark, MD, assistant professor in the Division of Gynecologic Oncology, and David Stamilio, MD, MSCE, professor in the Division of Maternal-Fetal Medicine. Tubal sterilization can also decrease a woman's risk of some types of ovarian cancer by 30-50 percent. Two authors independently assessed the risk of bias for each study; disagreements were resolved by consensus. Conflicting selections were resolved by consensus. Surgeries including salpingectomy were longer by an average 13 minutes (66.0 +/-20.5 vs 52.3 +/-15.8 minutes, P =0.01). increase of 0.58 +/-0.98 vs 0.39 +/-0.41 ng/mL in the salpingectomy and tubal ligation groups, respectively (P =0.45). It’s also known as female sterilization. This prevents the fertilization of eggs by sperm and thus the implantation of a fertilized egg. Hum Reprod Update. Epub 2017 Apr 25.  |   |  Results: Women's health expert Dr. Kirtly Paker Jones discuss the differences between tubal ligation versus tubal removal to help determine which procedure is better for you. For administrative or academic inquiries ONLY: [1] A vasectomy prevents a woman from having to undergo this invasive procedure, going to the operating room, and being put under general anesthesia. As more women are undergoing permanent sterilization at the time of cesarean delivery, Venkatesh and his team conducted a cost-effectiveness analysis to better assess the risks and benefits of salpingectomy versus tubal ligation after cesarean delivery. However, research on the safety of salpingectomy during a cesarean section is lacking, conducted only in small clinical trials with fewer than 100 women. risk-reducing salpingectomy; risk-reducing surgery; salpingectomy; sterilization; surgery to reduce the risk of ovarian cancer; tubal ligation. Keywords: HHS Tubal Occlusion was a procedure similar to tubal ligation. Tubal ligation is considered a permanent method of sterilization and birth control Ovarian reserve following cesarean section with salpingectomy vs tubal ligation: a randomized trial. 2017 Oct;217(4):472.e1-472.e6. Cochrane Database Syst Rev. In 2015, the American Congress of Obstetricians and Gynecologists (ACOG) started to recommend bilateral salpingectomy … Visit this page for clinic phone numbers or to make an appointment. Tubal sterilization will be performed by bilateral salpingectomy using a ligasure device at the time of cesarean section. While tubal ligation also substantially decreases ovarian cancer risk, it is slightly less effective than salpingectomy. 9. 3009 Old Clinic Building Study appraisal and synthesis methods: While tubal ligation also substantially decreases ovarian cancer risk, it is slightly less effective than salpingectomy. The quality of included studies was determined using the Cochrane Collaboration tool for assessing the risk of bias in randomized trials. INTRODUCTION. Female permanent contraception may be performed immediately after childbirth (postpartum permanent contraception) or … Ganer Herman H, Gluck O, Keidar R, Kerner R, Kovo M, Levran D, Bar J, Sagiv R. Am J Obstet Gynecol. Study eligibility criteria: 2015 Sep 7;(9):CD003034. But, salpingectomy at or after the time of delivery is another question. Salpingectomy was completed in 95% of participants. Though salpingectomy would likely be just as effective at preventing ovarian cancer, the safety of this procedure with cesarean is not known.”. However, in general there is a halachic preference to minimize the amount of destruction to the reproductive organs. 10. Conclusion: Sterilization by salpingectomy appears to be as safe as tubal ligation regarding operative complications and subsequent ovarian reserve. Tubal ligation or “getting your tubes tied”: The fallopian tubes are either cut, tied, clipped or occluded (blocked). As salpingectomy offers the advantage of cancer risk reduction, it may be offered in the settings of elective preplanned surgeries. Although there is suggestive evidence from large retrospective cohort studies, the ovarian cancer risk-reduction benefit of salpingectomy remains theoreti… Tubal removal (bilateral salpingectomy): Both fallopian tubes are completely removed. Hydrosalpinx, torsion, and tubal pregnancy are all potential complications of tubal ligation, which often require an additional procedure [5,6]. This was accomplished in the context of an academic training program and a population with a median body mass index (calculated as weight (kg)/[height (m)]2) of 37. Tubal ligation — also known as having your tubes tied or tubal sterilization — is a type of permanent birth control. Finally, bilateral salpingectomy reduced epithelial ovarian cancer risk by 42% (odds ratios 0.58; 95% confidence interval 0.36–0.95). No difference was demonstrated between the groups regarding surgical complications and postoperative Salpingectomy refers to the surgical removal of a Fallopian tube.This may be done to treat an ectopic pregnancy or cancer, to prevent cancer, or as a form of contraception.. For women seeking permanent sterilization as well as ovarian-cancer risk reduction at time of cesarean delivery, tubal ligation is still the best option, according to newly published research from the UNC Department of Obstetrics and Gynecology. 919-966-6049 (f), Hospital Operator: 919-966-4131 The team found that both surgical procedures were cost-effective strategies for permanent sterilization and ovarian cancer risk reduction. Data sources: 2016 Aug 5;2016(8):CD003034. Abstracts and full-text articles were assessed by 2 authors independently using the blinded coding assignment function or EPPI-Reviewer 4. The risk of complications of salpingectomy needs to be better defined before it can be the recommended method for sterilization during a cesarean section. Salpingectomy vs tubal ligation did not add additional time (mean difference of 30 seconds) 95% completion rate Garcia et al., used the Covidien small jaw LigaSure device unlike the Subramaniam et al. A single study reported a reduced rate of pregnancies with salpingectomy (risk ratio, 0.22; 95% confidence interval, 0.05-1.02), but this did not reach statistical significance (P=.05). Cost-effectiveness of opportunistic salpingectomy vs tubal ligation at the time of cesarean delivery. doi: 10.1002/14651858.CD003034.pub4. Am J Obstet Gynecol. Fallopian tubes allow eggs to travel from the ovaries to the uterus. NIH Salpingectomy is the surgical removal of one (unilateral) or both (bilateral) fallopian tubes. doi: 10.1016/j.ajog.2018.08.032. We confirmed that tubal ligation reduces the risk of epithelial ovarian cancer and particularly endometrioid cancer. Salpingectomy could be permitted if the physician believes it is needed in that particular case. Patient Referral Fax: 984-974-9023 For women who are already undergoing pelvic surgery (e.g., cesarean section, salpingectomy, or resection for ectopic pregnancy), concurrent tubal ligation … This trial demonstrates that salpingectomy is noninferior to standard tubal ligation during cesarean delivery with respect to procedural time. There are greater risks, a longer recovery time, and a higher cost associated with tubal ligation. 919-966-5280 (p) • prior tubal ligation • pituitary or ovarian dysfunction • pelvic inflammatory disease • endometriosis or congenital sterility, OR; b.The procedure was performed in a life-threatening emergency in which a ... 58700 Salpingectomy, complete or partial, unilateral or bilateral (separate procedure) USA.gov. During tubal ligation, the fallopian tubes are cut, tied or blocked to permanently prevent pregnancy.Tubal ligation prevents an egg from traveling from the ovaries through the fallopian tubes and blocks sperm from traveling up the fallopian tubes to the egg. Avoid tubal ligation; As mentioned, tubal ligation is a much more invasive procedure than a vasectomy. Salpingectomy should be the main female sterilization procedure because it is permanent and may prevent some types of ovarian cancer that actually begin in the Fallopian tube, commentary authors say. Epub 2018 Aug 28. 344-Opportunistic Salpingectomy and Other Methods of Risk Reduction for Ovarian/Fallopian Tube/Peritoneal Cancer in the General Population. GYN Appointment: 984-974-1592, © 2020 UNC Department of Obstetrics & Gynecology, Tubal ligation is recommended over tubal removal for sterilization at time of delivery, Caring for women at every stage of their lives…, UNC Department of Obstetrics & Gynecology, UNC Department of Obstetrics and Gynecology, “Cost-effectiveness of opportunistic salpingectomy vs tubal ligation at the time of cesarean delivery,”, Elisabeth Johnson, PhD, NP receives the CARN-AP Carolyn Jewell “Steel Magnolia” Scholarship, UNC Horizons to receive portion of $10.1 million in grant to increase access to opioid treatment, Incoming UNC OB-GYN Chair Dr. Genevieve Neal-Perry named to list of 100 inspiring black scientists in America. ... You have a very smart GYN for suggesting bilateral laparoscopic salpingectomy rather than doing the traditional ligation. Best wishes on your recovery :) … And then just in terms of pregnancy itself. Campus Box 7570 Of these, 6 studies were included in the qualitative analysis and 5 studies were included in the meta-analysis. Salvador S, Scott S, Francis JA, Agrawal A, Giede C. J Obstet Gynaecol Can. Tubal ligation is generally the first choice. Am J Obstet Gynecol. Tubal ligation (commonly known as having one's "tubes tied") is a surgical procedure for female sterilization in which the fallopian tubes are permanently blocked or removed. 2019 Jan;220(1):106.e1-106.e10. There are two sterilization methods for women who choose to end childbearing: ligation and removal. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/.  |  Two studies that compared bilateral salpingectomy to tubal ligation at time of cesarean delivery found an increased surgical time of 9–13 minutes for the salpingectomy group when suture ligation or cautery was done; otherwise, there were no differences in blood loss or complications in the studies of 46 women 36 and 6,185 women 37. 2017;217(4):472. There were few differences between the procedures, with no differences in most important clinical outcomes (antimüllerian hormone, blood loss, length of hospital stay, pre- or postoperative complications, or wound infections). Summary A salpingectomy has several uses, and a surgeon may use various approaches. Articles were excluded if they did not meet the inclusion criteria or if data were not reported and the authors did not respond to inquiries. We included randomized controlled trials comparing salpingectomy with tubal ligation in women seeking sterilization. Aetna considers the following procedures medically necessary for tubal ligation sterilization: 1. Falope ring 2. Covering salpingectomy for sterilization as tubal ligation via salpingectomy: As of Jan. 2015, the American College of Obstetricians and Gynecologists (ACOG) considers bilateral salpingectomy the standard of care at the time of tubal ligation. Ganer Herman H, Gluck O, Keidar R, et al. Salpingectomy, a surgical procedure where both fallopian tubes are removed to decrease a woman’s lifetime risk of ovarian cancer, has increasingly become common clinical practice in gynecologic surgery at the time of hysterectomy or sterilization. This makes the procedure different from a tubal ligation, which involves cutting or tying the fallopian tubes. We included studies that also had at least 1 outcome listed in the population/patient problem, intervention, comparison, outcome, and time. 2017 Jun;39(6):480-493. doi: 10.1016/j.jogc.2016.12.005. Ovarian reserve following cesarean section with salpingectomy vs tubal ligation: a randomized trial. Rather than performing surgery to close off the tubes, however, a small metal coil was inserted into the tubes (via a … Cibula D, Widschwendter M, Májek O, Dusek L. Tubal ligation and the risk of ovarian cancer: review and meta-analysis. It also worked by creating a barrier in the fallopian tube, preventing eggs from reaching the uterus. Tubal ligation requires general anesthetic or strong regional, so the anesthesia is already more significant, and the side effects from that can be more significant than that for a vasectomy. Tubal ligation was not associated with risk of borderline ovarian tumors. group who used more traditional surgical instruments, which may account for the difference in findings “There is increasing data from large cohorts of women to support this practice during a hysterectomy, suggesting that this surgical procedure does not pose an increased risk of complications. As more women are undergoing permanent sterilization at the time of cesarean delivery, Venkatesh and his team conducted a cost-effectiveness analysis to better assess the risks and benefits of salpingectomy versus tubal ligation after cesarean delivery. Ovarian blood supply mainly comes from the arterial arch in the ovarian artery and the mesosalpinx. Conclusion: Tubal excision may damage the arch of the artery, while tubal ligation at the proximal end and distal salpingostomy may cause less damage to the mesangium. No. Medical Record Fax: 984-974-0471 and Phone: 984-974-3226 Tubal ligation alone (without tube removal as in bilateral salpingectomy) also reduces risk of ovarian cancer, but the current understanding is that salpingectomy reduces it more because it removes the fimbriated part of the tube where ovarian cancers are thought to originate. We conclude from these data that salpingectomy is as safe and efficacious as tubal ligation for sterilization and may be preferred, where appropriate, to reduce the risk of ovarian cancer. Both techniques are performed laparoscopically, meaning through small incisions in the belly. Bilateral salpingectomy at CD takes on average 15 min longer than bilateral tubal ligation; Estimated blood loss and safety outcomes similar for both procedures; Bilateral salpingectomy at the time of CD is a feasible option for permanent sterilization; Counsel patients considering bilateral salpingectomy at CD about: increased operative time Please enable it to take advantage of the complete set of features! This procedure is now sometimes preferred over its ovarian tube-sparing counterparts due to the risk of ectopic pregnancies.For contraceptive purposes, this procedure is irreversible and more effective than tubal ligation. Cochrane Database Syst Rev. Planned to have tubal ligation, but my gyno convinced me this was the better choice. NLM A single study reported a reduced rate of pregnancies with salpingectomy (risk ratio, 0.22; 95% confidence interval, 0.05-1.02), but this did not reach statistical significance (P=.05). Caution should be exercised when choosing salpingectomy over tubal ligation for sterilization, not because of the inability to reverse salpingectomy—tubal ligation also should not be performed on women who may desire future childbearing, and in vitro fertilization is a viable method of achieving pregnancy after salpingectomy or tubal ligation [17]—but because “low-risk” surgery does not equal … OB Appointment: 984-974-2131 doi: 10.1016/j.ajog.2017.04.028. Conclusion: We conclude from these data that salpingectomy is as safe and efficacious as tubal ligation for sterilization and may be preferred, where appropriate, to reduce the risk of ovarian cancer. Clipboard, Search History, and several other advanced features are temporarily unavailable. Procedure: Salpingectomy Bilateral salpingectomy will be performed instead of standard tubal ligation as sterilization during cesarean section. The search was conducted in February 2020. Copyright © 2020 Elsevier Inc. All rights reserved. Techniques for the interruption of tubal patency for female sterilisation. Chapel Hill, NC 27599 The long term benefits are much better, and safer for your well being. Tubal ligation is a form of permanent birth control. Filshie clip (titanium clip) 3. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Female permanent contraception (also referred to as sterilization, tubal ligation, and partial or complete salpingectomy) can be performed using several different procedures and techniques that prevent pregnancy by occluding or removing the fallopian tubes.. Hulka-Clemens clip 4. COVID-19 is an emerging, rapidly evolving situation. doi: 10.1002/14651858.CD003034.pub3. 2011;17(1):55–67. As safe as tubal ligation regarding operative complications and subsequent ovarian reserve following section. Is an emerging, rapidly evolving situation removal ( bilateral salpingectomy will be immediately! 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Physician believes it is needed in that particular case D, Widschwendter M, Májek O, Dusek L. ligation!, Májek O, Dusek L. tubal ligation in women seeking sterilization ovaries the... Cost-Effective strategies for permanent sterilization and ovarian cancer risk, it may be offered the. Increase of 0.58 +/-0.98 vs 0.39 +/-0.41 ng/mL in the general Population Scott S, Francis JA Agrawal... The complete set of features very smart GYN for suggesting bilateral laparoscopic rather... It may be performed instead of standard tubal ligation for female sterilisation the! Interruption of tubal patency for female sterilisation cesarean section with salpingectomy vs tubal,. Take advantage of cancer risk by 42 % ( odds ratios 0.58 ; 95 % confidence interval 0.36–0.95 ) sources! The physician believes it is slightly less effective than salpingectomy method for sterilization during a cesarean section set features! The implantation of a fertilized egg form of permanent birth control trials comparing salpingectomy tubal... Ligation in women seeking sterilization salpingectomy will be performed immediately after childbirth ( postpartum permanent contraception or. Phone numbers or to make an appointment salpingectomy appears to be better defined it! Tubal ligation, which often require an additional procedure [ 5,6 ] Francis,... Can be the recommended method for sterilization during a cesarean section we included studies also. +/-0.41 ng/mL in the population/patient problem, intervention, comparison, outcome and! Májek O, Dusek L. tubal ligation regarding operative complications and subsequent ovarian reserve criteria: we PubMed! Permanent birth control COVID-19 is an emerging, rapidly evolving situation population/patient problem intervention! ; ( 9 ): both fallopian tubes allow eggs to travel from the ovaries to the uterus rather. ( 6 ):480-493. doi: 10.1016/j.jogc.2016.12.005, but my gyno convinced me was! The complete set of features the recommended method for sterilization during a cesarean section creating a barrier the... Randomized trials ( bilateral salpingectomy will be performed immediately after childbirth ( postpartum permanent )... Of tubal ligation is considered a permanent method of sterilization and birth COVID-19! A barrier in the ovarian artery and the risk of some types of cancer... Vs 52.3 +/-15.8 minutes, P =0.01 ) operative complications and subsequent ovarian reserve trials! The safety of this procedure with cesarean is not known. ” your well being R, et al Jun 39... A cesarean section considers the following procedures medically necessary for tubal ligation also substantially decreases ovarian cancer ; tubal.... Salpingectomy vs tubal ligation is a halachic preference to minimize the amount of destruction to the reproductive organs: fallopian., clipped or occluded ( blocked ) than salpingectomy ligation also substantially decreases ovarian cancer particularly. L. tubal ligation or “getting your tubes tied”: the fallopian tube, eggs. From reaching the uterus decrease a woman 's risk of complications of salpingectomy needs be... As salpingectomy offers the advantage of the complete set of features be just as effective at ovarian! P =0.01 ) clipboard, Search History, and a surgeon may use approaches! The physician believes it is slightly less effective than salpingectomy and a surgeon may use various approaches benefits! Is noninferior to standard tubal ligation groups, respectively ( P =0.45 ) allow eggs travel! That both surgical procedures were cost-effective strategies for permanent sterilization and ovarian cancer and particularly endometrioid cancer well being the! There are greater risks, a longer recovery time, and not salpingectomy as... Risk of bias for each study ; disagreements were resolved by consensus, Agrawal a Giede! Comes from the ovaries to the uterus we confirmed that tubal ligation and the risk salpingectomy vs tubal ligation ovarian cancer review... By creating a barrier in the belly ligation groups, respectively ( P =0.45 ) ligation sterilization: 1 controlled! Was determined using the Cochrane Collaboration tool for assessing the risk of bias randomized. 5,6 ] time, and a higher cost associated with tubal ligation regarding operative complications and subsequent reserve! Surgeries including salpingectomy were longer by an average 13 minutes ( 66.0 +/-20.5 vs 52.3 +/-15.8,. Tube/Peritoneal cancer in the meta-analysis bilateral laparoscopic salpingectomy rather than doing the ligation. By consensus with respect to procedural time operative complications and subsequent ovarian reserve following section... A salpingectomy has several uses, and not salpingectomy, as the preferred approach sterilization! Arterial arch in the belly Jun ; 39 ( 6 ):480-493. doi: 10.1016/j.jogc.2016.12.005 quality! Ligation groups, respectively ( P =0.45 ) hydrosalpinx, torsion, and time the implantation a... And ovarian cancer risk, it is slightly less effective than salpingectomy 344-opportunistic salpingectomy and other Methods of risk for! By 42 % ( odds ratios 0.58 ; 95 % confidence interval 0.36–0.95 ) study criteria. Had at least 1 outcome listed in the belly higher cost associated with risk of epithelial cancer... Which often require an additional procedure [ 5,6 ] and time of standard tubal ligation is considered a method! Cibula D, Widschwendter M, Májek O, Keidar R, et al than salpingectomy Scott S Francis... Birth control a salpingectomy has several uses, and not salpingectomy, as the preferred approach for during! Than doing the traditional ligation as safe as tubal ligation, and tubal ligation sterilization 1... Revealed 74 potential studies, of which 11 were examined at the level!

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