A randomized controlled trial of two techniques of salpingectomy during cesarean section

Abstract

Background

Total salpingectomy during benign gynecologic surgery is recommended after completion of childbearing, to reduce the risk for developing ovarian cancer.

Objective

To assess operating time and complication rates of "traditional" salpingectomy, using the "Knot and Cut" technique, compared with bipolar salpingectomy for sterilization at the time of cesarean section.

Study Design

this was a randomized controlled trial. Women undergoing planned cesarean delivery who desired sterilization were randomized to traditional salpingectomy or bipolar salpingectomy. The bipolar salpingectomy was performed using the LigaSure Precise^TM. The primary outcome was the surgical time of the salpingectomy procedure. Secondary outcomes included total cesarean section time and associated bleeding parameters. We estimated that 42 patients would provide 80% power and a two-sided alpha of 0.05 to identify a 10- minute difference in the primary outcome.

Results

26 women were randomized to bipolar salpingectomy and 25 to traditional salpingectomy. Baseline demographics characteristics were similar between the groups. Six procedures were converted from traditional to bipolar salpingectomy, and two traditional salpingectomies have failed. The surgical time (16.16±9.53 vs. 5.19±3.57 minutes, p<0.001), estimated blood loss (928.08±414.66 ml vs. 677.15±380.42 ml, p=0.029) and need for blood transfusion (20% vs. 0%, p=0.016) were significantly greater in the traditional salpingectomy than the bipolar salpingectomy group. The cesarean section time was similar (88.92±17.87 vs. 88.23±19.85 minutes, p=0.89). Hospitalization time was significantly longer following traditional salpingectomy than bipolar salpingectomy (5.24±2.27 days vs. 3.92±2.01 days, p=0.034).

Conclusion

"Traditional" salpingectomy is associated with longer surgical time, greater blood loss, risk for blood transfusion, and hospitalization time compared to "bipolar" salpingectomy. In practices in which "bipolar" is available, it should be preferred for salpingectomy over alternative methods.