Wide excision of soft tissues adjacent to the ovary and fallopian tube does not impair the ovarian reserve in women undergoing prophylactic bilateral salpingectomy Results from a randomized controlled trial

Capsule:
Wide excision of the mesosalpinx does not impair ovarian reserve in women undergoing prophylactic salpingectomy. Moreover, wide salpingectomy is safe in terms of blood loss and postoperative recovery.

Authors:
Roberta Venturella, M.D., Michele Morelli, M.D., Ph.D., Daniela Lico, M.D., Annalisa Di Cello, M.D., Morena Rocca, M.D., Angela Sacchinelli, M.D., Rita Mocciaro, M.D., Pietro D’Alessandro, M.D., Ph.D., Antonio Maiorana, M.D., Salvatore Gizzo, M.D., Fulvio Zullo, M.D., Ph.D.

Volume 104, Issue 5, Pages 1332-1339

Abstract:

Objective:
To study the effects of the wide excision of soft tissues adjacent to the ovary and fallopian tube on ovarian function and surgical outcomes in women undergoing laparoscopic bilateral prophylactic salpingectomy.

Design:
Randomized, controlled trial.

Setting:
Teaching hospital.

Patient(s):
One hundred eighty-six women undergoing laparoscopic surgery for uterine myoma (n = 143) or tubal surgical sterilization (n = 43).

Intervention(s):
Patients were randomly divided into two groups. In group A (n = 91), standard salpingectomy was performed. In group B (n = 95), the mesosalpinx was removed within the tubes. Prior to and 3 months after surgery, antimüllerian hormone (AMH), FSH, three-dimensional antral follicle count (AFC), vascular index (VI), flow index (FI), vascular-flow index (VFI), and OvAge were recorded for each patient.

Main Outcome Measure(s):
Ovarian reserve modification (Δ) before and after surgery was assessed as the primary outcome. Operative time, variation of the hemoglobin level (ΔHb), postoperative hospital stay, postoperative return to normal activity, and complication rate were assessed as secondary outcomes.

Result(s):
No significant difference was observed between groups for ΔAMH, ΔFSH, ΔAFC, ΔVI, ΔFI, ΔVFI, and ΔOvAge. Moreover, the groups were similar for operative time, ΔHb, postoperative hospital stay, postoperative return to normal activity, and complication rate.

Conclusion(s):
Even when the surgical excision includes the removal of the mesosalpinx, salpingectomy does not damage the ovarian reserve. Moreover, wide salpingectomy with excision of the mesosalpinx did not alter blood loss, hospitalization stay, or return to normal activities.

Clinical Trial Registration Number:
NCT02086370.

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