Ovarian and Fallopian Tube Removal Overview

Unilateral salpingo-oophorectomy is the surgical removal of a fallopian tube and an ovary. If both sets of fallopian tubes and ovaries are removed, the procedure is called a bilateral salpingo-oophorectomy.

The fallopian tube and ovary are well situated in the pelvis and nearly all operations for nonmalignant problems of these organs can be best done using the laparoscopic approach.

The operations are called adnexal surgery and include:

  • Ovarian cystectomy – Removal of an ovarian cyst with preservation of the ovary
  • Oophorectomy – Removal of the ovary
  • Salpingectomy – Removal of the Fallopian tube
  • Salpingotomy – Opening the tube to remove an abnormality e.g. ectopic pregnancy
  • Adhesolysis – Freeing the tube or ovary from adhesions to reduce pain or improve fertility

Many of these operations can be performed as day surgery. It is advisable to discuss your recovery needs with your doctor to ensure the best planning for you.

Purpose

This surgery is performed to treat ovarian or other gynecological cancers, or infections caused by pelvic inflammatory disease.

Occasionally, removal of one or both ovaries may be done to treat endometriosis, a condition in which the lining of the uterus (the endometrium) grows outside of the uterus (usually on and around the pelvic organs).

The procedure may also be performed if a woman has been diagnosed with an ectopic pregnancy in a fallopian tube and a salpingostomy (an incision into the fallopian tube to remove the pregnancy) cannot be done.

If only one fallopian tube and ovary are removed, the woman may still be able to conceive and carry a pregnancy to term. If both are removed, however, the woman is rendered permanently infertile.

This procedure is commonly combined with a hysterectomy (surgical removal of the uterus); the ovaries and fallopian tubes are removed in about one-third of hysterectomies.

Until the 1980s, women over age 40 having hysterectomies routinely had healthy ovaries and fallopian tubes removed at the same time.

Many physicians reasoned that a woman over 40 was approaching menopause and soon her ovaries would stop secreting estrogen and releasing eggs.

Removing the ovaries would eliminate the risk of ovarian cancer and only accelerate menopause by a few years.

In the 1990s, the thinking about routine salpingooophorectomy began to change. The risk of ovarian cancer in women who have no family history of the disease is less than 1%.

Moreover, removing the ovaries increases the risk of cardiovascular disease and accelerates osteoporosis unless a woman takes prescribed hormone replacements.

Advantages of Laparoscopic Adnexal Surgery

  • Small incisions and less scarring
  • Better views of the tubes and ovaries
  • Gentler handling of the body tissues and organs during the operation
  • Less blood loss during the operation
  • Less postoperative pain
  • Less postoperative narcotic use for pain relief
  • Shorter hospitalisation
  • Faster overall recovery with an earlier return to normal activity

Techniques of Laparascopic Adnexal Surgery

Preoperative preparation may involve a shave and a small enema. Fasting for 6 hours preop is required.

A general anaesthetic is administered.

The laparoscope and other instruments are introduced as described.

The blood supply to the tube or ovary is secured if removal is to occur and then the tube or ovary is freed from its supports.

If the tube or ovary is to be saved the cyst or abnormality is removed and the tube or ovary repaired.

The specimen is removed and the wounds repaired.

Recovery

Immediate postoperative recovery involves either discharge from the day surgery centre or a night in hospital.

Patients are welcome to rest in hospital for as long as they need to. Patients will be given as much pain relief as they request to make sure they are comfortable either as tablets or injections.

The first few days at home should be taken very easily. The patient should have someone to help. Plenty of rest and fluids are advisable.

Exercise your calf muscles to prevent clots. Oral pain relief e.g. Panadeine/Panadol may be needed, especially at night. Generally recovery will be complete within a week or so.

All patients should individually assess their recovery rate. Some may need more time off work than others and certificates will always be provided.

Risks of Adnexal Surgery

These risks apply to whichever method is used to approach the adnexa.

Infection – Infection rates are low and are mainly superficial wound infections treated with bathing, dressing and perhaps antibiotics. Rarely an internal infection can occur.

Bleeding – At the time of the operation some blood will be lost. Very rarely this can be serious and require some emergency treatment such as transfusion.

Damage to bowel, bladder and ureter – These structures are very close to the adnexa and can rarely be damaged. The risks are about 1 in 500-600 cases. Damage detected at the time of surgery is repaired immediately and will often not have serious consequences.

Sometimes the injury can be undetected or develop over several days after surgery e.g. where a burn is made to stop bleeding.

This may cause a delay in diagnosis and a more serious illness.

Deep Venous Thrombosis or Pulmonary Embolus – A clot can form in the leg or pelvic veins and travel to the lungs. The risk it will happen is about 1 in 400-500.

This is serious and can rarely be fatal. Tell your doctor if these have happened to you before or if you have a family history.

During the surgery a number of precautions are taken to prevent these. Early mobilisation after laparoscopic surgery may also reduce the risk compared to larger incision operations.

Other risks of laparoscopy – As described in the Laparoscopic Surgery Information Sheet.

Adhesions (scarring) – can develop as a consequence of surgery. Sometimes these can cause pain or reduce fertility.

Laparoscopic surgery is thought to reduce the risk of adhesions compared to when the same operation is done through a large incision.

Diagnosis/Preparation

Before surgery, the doctor will order blood and urine tests, and any additional tests such as ultrasound or x rays to help the surgeon visualize the woman’s condition.

The woman may also meet with the anesthesiologist to evaluate any special conditions that might affect the administration of anesthesia. A colon preparation may be done, if extensive surgery is anticipated.

On the evening before the operation, the woman should eat a light dinner, then take nothing by mouth, including water or other liquids, after midnight.

Aftercare

If performed through an abdominal incision, salpingo-oophorectomy is major surgery that requires three to six weeks for full recovery.

However, if performed laparoscopically, the recovery time can be much shorter. There may be some discomfort around the incision for the first few days after surgery, but most women are walking around by the third day.

Within a month or so, patients can gradually resume normal activities such as driving, exercising, and working.

Immediately following the operation, the patient should avoid sharply flexing the thighs or the knees. Persistent back pain or bloody or scanty urine indicates that a ureter may have been injured during surgery.

If both ovaries are removed in a premenopausal woman as part of the operation, the sudden loss of estrogen will trigger an abrupt premature menopause that may involve severe symptoms of hot flashes, vaginal dryness, painful intercourse, and loss of sex drive.

(This is also called “surgical menopause.”) In addition to these symptoms, women who lose both ovaries also lose the protection these hormones provide against heart disease and osteoporosis many years earlier than if they had experienced natural menopause.

Women who have had their ovaries removed are seven times more likely to develop coronary heart disease and much more likely to develop bone problems at an early age than are premenopausal women whose ovaries are intact.

For these reasons, some form of hormone replacement therapy (HRT) may be prescribed to relieve the symptoms of surgical menopause and to help prevent heart and bone disease.

Reaction to the removal of fallopian tubes and ovaries depends on a wide variety of factors, including the woman’s age, the condition that required the surgery, her reproductive history, how much social support she has, and any previous history of depression.

Women who have had many gynecological surgeries or chronic pelvic pain seem to have a higher tendency to develop psychological problems after the surgery.

Risks

Major surgery always involves some risk, including infection, reactions to the anesthesia, hemorrhage, and scars at the incision site.

Almost all pelvic surgery causes some internal scars, which in some cases can cause discomfort years after surgery.

Potential complications after a salpingo-oophorectomy include changes in sex drive, hot flashes, and other symptoms of menopause if both ovaries are removed.

Women who have both ovaries removed and who do not take estrogen replacement therapy run an increased risk for cardiovascular disease and osteoporosis.

Women with a history of psychological and emotional problems before an oophorectomy are more likely to experience psychological difficulties after the operation.

Normal results

If the surgery is successful, the fallopian tubes and ovaries will be removed without complication, and the underlying problem resolved.

In the case of cancer, all the cancer will be removed. A woman will become infertile following a bilateral salpingo-oophorectomy.

Source & More Info: Surgery Encyclopedia and Gynaecologymolloy.com

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