Feasibility of interval laparoscopic permanent contraception via bilateral salpingectomy
Westberg J, Scott F, Creinin MD. Safety outcomes of female sterilization by salpingectomy and tubal occlusion. Contraception. 2017;95(5):505-508.
In this retrospective study, authors used billing data to identify women undergoing interval laparoscopic permanent contraception at a single academic medical center. They educated physicians and patients about the potential benefits to ovarian cancer risk with total salpingectomy (similar to the educational initiative done in British Columbia) and discussed the requirement for the extra incision and more time for the surgery. From 2013 to 2015 use of salpingectomy for permanent contraception changed from 45% of the procedures to 85%, a fairly dramatic trend.18 With these data, the authors compared outcomes between the women receiving tubal occlusive procedures and women receiving bilateral salpingectomy.
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Details of surgical time and complications
Tubal occlusion procedures were performed through 2 abdominal ports, and device placement was at the discretion of the provider. Bilateral salpingectomies were performed through 3 abdominal port sites with an electrothermal bipolar tissue-sealing instrument. A total of 149 procedures were identified, 68 tubal occlusions (19% Falope rings, 32% bipolar cautery, and 47% Filshie clips) and 81 bilateral salpingectomies.
The surgical time average (SD) was 6 minutes longer for the salpingectomies (44 [13] minutes vs 38 [15] minutes; P = .018). As would be expected, more experienced residents had shorter surgical times when compared with less experienced residents for both procedures (FIGURE 2).15 Similar rates of both immediate and short-term surgical complications were noted. One immediate complication was reported in each group, both of which were secondary to anesthesia issues.
Interestingly, short-term complications were lower in the salpingectomy group (4.9%) versus the tubal occlusion group (14.7%), although this difference was barely not statistically significant (P = .051). These complications included 1 incisional site infection requiring oral antibiotics and 3 cases of increased pain in the salpingectomy group and 4 incisional site infections with 6 patients reporting increased pain in the tubal occlusion group.
WHAT THIS EVIDENCE MEANS FOR PRACTICE
This retrospective analysis provides further reassurance regarding the safety of offering bilateral salpingectomy to patients desiring permanent contraception. This study again consistently demonstrates that bilateral salpingectomy increases the operative time, but only minimally, which is unlikely clinically significant, especially when considering the potential benefits from total salpingectomy (increased ovarian cancer protection, higher contraceptive efficacy, decreased ectopic pregnancy rates, reduced risk of future surgeries for such tubal pathology as hydrosalpinx, etc). The study also shows that educational initiatives targeted at providers likely will increase acceptability as well as uptake of this practice for permanent contraception.