Salpingectomy: How are Fallopian Tubes Extracted?

By (gynecologist), BSc, MSc (embryologist) and (invitra staff).
Last Update: 04/24/2020

Salpingectomy is a surgical procedure that consists of the removal of a woman's fallopian tubes, thus causing sterility.

Salpingectomy can be unilateral, if only one tube is removed, or bilateral, if both tubes are removed.

The indications for salpingectomy are as diverse as the techniques used in surgery.

What is salpingectomy?

Salpingectomy is the removal of one or both of a woman's fallopian tubes due to pathologies or alterations that may affect her reproductive system.

Some specialists use the term salpingectomy to refer to tubal ligation surgery, but this is incorrect.

Tubal ligation is a definitive method of sterilization in which only the tubes are cut or blocked to prevent pregnancy, not completely removed.

The consequence of removing the fallopian tubes is that, once ovulation has taken place, the egg will be lost and it will not be able to meet the sperm for fertilization. Therefore, natural pregnancy with bilateral salpingectomy is impossible.

In the case of a unilateral salpingectomy, the woman would still be fertile and could achieve a natural pregnancy thanks to the other tube she keeps. However, it should be taken into account whether ovulation occurs on the right side or the left side of each particular month.

How is it carried out?

Salpingectomy can be done using two surgical techniques:

Laparoscopy
is a non-invasive surgery that consists of introducing an optical system through a small incision in the abdomen to observe the cavity. Another small incision is made just above the pubic hair, and the tubes are removed with a tube. It is the most widely used technique today, as women can lead normal lives after 48 hours.
Laparotomy
is more invasive than the previous one because it requires a 5 to 10 cm incision in the lower abdomen. Currently, there is a variant known as a mini-laparotomy, in which a smaller incision of about 5 cm is made, sufficient to allow access to and removal of the tubes.

The choice of one of these methods depends on several factors: age, weight, previous surgeries on the abdomen, diseases, etc.

Indications

The possible pathologies and alterations that require the removal of the fallopian tubes are the following:

Ectopic pregnancy
implantation of the embryo in the tube instead of the uterus. The growth of the embryo in the tube can cause it to rupture, so it has to be removed. In this case, the salpingectomy is unilateral.
Endometriosis
growth of endometrial tissue outside the uterus. If the lesions caused in the tubes are very severe, it will be necessary to perform a salpingectomy, which is usually bilateral.
Salpingitis
inflammation of the fallopian tubes caused by an infection. In case of severe chronic infection, where antibiotics do not affect, salpingectomy will be necessary.
Hidrosalpinx
blocking and accumulating of fluid in the tube that causes it to dilate. In the most serious cases, when the hydrosalpinx is larger than 3 cm, one or both tubes are removed.
Hysterectomy
when it is necessary to remove the uterus, a salpingectomy is usually performed together, as preserving the tubes could bring complications and they do not bring any benefit. The ovaries, on the other hand, are preserved so as not to cause early menopause.
Prevention of ovarian cancer
some studies claim that removing the tubes may reduce the risk of ovarian cancer in women with a genetic predisposition.

Side effects

Salpingectomy is a very safe technique that usually does not cause any short or long term complications. In any case, the possible side effects will depend on the surgical technique used.

On the one hand, laparoscopy involves a very small incision and therefore recovery time is short. However, it is possible that in the days following the surgery, the patient may experience abdominal discomfort and swelling due to the gas being injected to expand the abdomen.

On the other hand, the surgical wound from the laparotomy is larger, which implies more pain in this area and special care to treat the scar. There is also an increased risk of bleeding and infection, although this is not common.

Finally, it should be noted that the risk of reaction to anesthesia is the same for both techniques and that serious injury to internal organs rarely occurs.

Pregnancy after salpingectomy

Natural pregnancy is not possible if there is no integrity in at least one of the fallopian tubes, as discussed above.

Despite this, even in the most severe cases of bilateral salpingectomy, the patient can still become pregnant thanks to assisted reproduction techniques such as in vitro fertilization (IVF).

If you need to undergo IVF to become a mother, we recommend that you generate your Fertility Report now. In 3 simple steps, it will show you a list of clinics that fit your preferences and meet our strict quality criteria. Moreover, you will receive a report via email with useful tips to visit a fertility clinic for the first time.

In IVF, the eggs are obtained directly from the woman's ovaries and therefore no tubal functionality is required. The embryos are fertilized in the laboratory with the sperm of the couple or an anonymous donor and then transferred directly to the mother's uterus.

The uterus, however, is strictly necessary for conception. Even when it is necessary to remove the uterus along with the tubes, attempts are always made to leave the ovaries so that the woman retains the production of sex hormones and to allow the possibility of having a biological child should she consider surrogacy in the future.

If you are interested in knowing what surrogacy treatment consists of in a more detailed way, we invite you to visit the following post: What is surrogacy?

FAQs from users

In what situations is it strictly necessary to perform a salpingectomy?

By Dr. José Luis Gómez Palomares (gynecologist).

Salpingectomy is the surgical removal of one or both fallopian tubes.

In medicine, there is not always data to support diagnostic or therapeutic behavior. This is not the case when, in the context of the study of reproductive dysfunction, a hydrosalpinx appears.

A hydrosalpinx is the dilation of the fallopian tube due to the presence of fluid inside it. When diagnosed, salpingectomy before in vitro fertilization treatment improves the chances of achieving a pregnancy. This is according to the review carried out by the Cochrane Library, probably the most rigorous and reliable organization of researchers when making recommendations in health sciences.

Therefore this would be a case where salpingectomy would be highly advisable. This is what science says but the Law makes clear the right to patient autonomy. The law says: "Any action in the field of health of a patient needs the free and voluntary consent of the affected person, once, received the information provided in Article 4, has assessed the options specific to the case". Because of this bioethical principle of autonomy, the patient can decide, even though she knows that the prognosis of the in vitro fertilization treatment worsens, not to undergo a salpingectomy. The concept of "strictly necessary" is therefore relegated to what the patient, properly informed, decides.

Is it possible to achieve natural pregnancy with unilateral salpingectomy?

By Zaira Salvador BSc, MSc (embryologist).

Yes, but it is more expensive because ovulation must occur through the ovary with the tube intact for there to be a chance of fertilization and pregnancy.

In the event of not achieving a natural pregnancy, it is possible to control ovulation with hormonal medication and to schedule sexual intercourse on the fertile days. It is also possible to try artificial insemination to increase the possibility of pregnancy.

What is partial salpingectomy?

By Zaira Salvador BSc, MSc (embryologist).

As the name implies, partial salpingectomy is the cutting and removal of a segment of the fallopian tube. This method is the most commonly used to perform a tubal ligation and is known as Pomeroy.

Suggested for you

The extirpation of the fallopian tube is necessary in severe cases of a tubal factor in women. If you are interested in this topic, you can continue reading in the next post: Tubal Factor Infertility- Causes & Treatment.

We have talked about in vitro fertilization as a fertility treatment for getting pregnant. To find out what this treatment consists of, we recommend that you read on at the following link: What is IVF?

Our editors have made great efforts to create this content for you. By sharing this post, you are helping us to keep ourselves motivated to work even harder.

References

Authors and contributors

Dr. José Luis Gómez Palomares
Dr. José Luis Gómez Palomares
Gynecologist
Degree in Medicine from the University of Valencia, specialized in Obstetrics and Gynecology at the Son Dureta Hospital in Palma de Mallorca. He has an extensive career as a gynecologist specializing in assisted reproduction and is also a scientific disseminator through the Youtube channel Feliztividad: hábitos de éxito y diferentes podcast. More information about Dr. José Luis Gómez Palomares
Licence number: 280705568
 Zaira Salvador
Zaira Salvador
BSc, MSc
Embryologist
Bachelor's Degree in Biotechnology from the Technical University of Valencia (UPV). Biotechnology Degree from the National University of Ireland en Galway (NUIG) and embryologist specializing in Assisted Reproduction, with a Master's Degree in Biotechnology of Human Reproduction from the University of Valencia (UV) and the Valencian Infertility Institute (IVI) More information about Zaira Salvador
License: 3185-CV
Adapted into english by:
 Romina Packan
Romina Packan
inviTRA Staff
Editor and translator for the English and German edition of inviTRA. More information about Romina Packan

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