The November, 2017, issue of the American Journal of Obstetrics and Gynecology
discussed the benefits of removing fallopian tubes at the time of vaginal hysterectomy. Removal of the tubes at the time of abdominal or laparoscopic hysterectomy done for benign disease is becoming more routine. It was thought that removing the tubes during a vaginal hysterectomy would lead to more complications and blood loss, but the study published demonstrated that the risks were quite low when compared to the decrease in ovarian cancer and deaths. The authors recommended that prophylactic removal of the fallopian tubes be considered when a vaginal hysterectomy is done. This can be accomplished in about 80% of patients, while in 20% it may not be possible to remove both tubes. Why take out the tubes when not planning to remove the ovaries?
As more prophylactic salpingo-oophorectomies (removal of the tubes and ovaries for prevention) have been performed, largely due to increased testing for the BRCA gene, pathologists have noted that women at high risk for ovarian cancer have been found to have more serous intraepithelial cancers in the fallopian tubes. These are felt to be the precursor lesions for high grade ovarian and peritoneal cancers. The removal of the fallopian tubes can lower the risk of a subsequent diagnosis of ovarian cancer. In women with the BRCA gene, it is recommended that the ovaries be removed after childbearing. Removing ovaries in a premenopausal women can have serious health consequences including menopausal symptoms, vaginal dryness and painful intercourse, and an increased risk of heart disease and osteoporosis. Removal of the fallopian tubes, with subsequent removal of the ovaries after menopause, is a strategy that may reduce ovarian cancer risk, but optimize the benefits of estrogen for women in their 40's who are at risk for ovarian cancer. Although more studies are in progress, the current data points to a favorable risk/benefit ratio in favor of removing fallopian tubes during hysterectomy for benign disease.
Marilyn Jerome, MD
Foxhall Ob-Gyn Associates
American Journal of Obstetrics and Gynecology, November 2017
Risks and benefits of opportunistic salpingectomy during vaginal hysterectomy: a decision analysis. Cadish, et al.
Feasibility of prophylactic salpingectomy during vaginal hysterectomy. Antosh, et al.
Prophylactic bilateral salpingectomy at vaginal hysterectomy: time for a "policy"?,
Rosanne Kho, MD