Staff Members - Benha University
Impact of bilateral total salpingectomy versus standard tubal ligation at time of cesarean section on ovarian reserve: A randomized controlled trial
Evidence Based Women's Health Journal • 2018
Publication Information
Authors
Mohamed Anwar Elnory, Ashraf Nassif Mahmoud Elmantwe
Keywords
Anti-müllerian hormone, cesarean section, ovarian cancer, ovarian reserve, sterilization, total salpingectomy,
tubal ligation
Journal
Evidence Based Women's Health Journal
Publisher
Not Available
Volume
Not Available
Issue
Not Available
Pages
Not Available
publication.type
Local
Paper Link
Open Link
Supplementary Materials
Not Available
Abstract
Aim of the work: The objective of this trial was to compare between bilateral total salpingectomy (BTS) as a theoretically
more effective ovarian cancer (OvCa) risk-reducing primary prevention and bilateral partial salpingectomy (BPS) [stander
tubal ligation (STL)] procedures at time of cesarean section (CS) for parturients who completed their reproductive desire
and requesting permanent sterilization regard to the impacts of both procedures on ovarian reserve parameters at one year
post-sterilization as well as the surgical consequences of both procedures.
Patients and Methods: This is a prospective, randomized, open-label, concealed allocation, parallel group, superiority
trial was conducted at three surgical sites in El-Qulobia, Egypt including Benha University Hospital, Obstetrics and
Gynecology Department between October 2015 and October 2017. 120 parturients undergoing CS were allocated to
BTS (intervention group) (60) and BPS (control group) (60). Main outcomes were one year post-sterilization differences
in ovarian reserve (OR) parameters including hormonal as well as two-dimensional and three-dimensional transvaginal
ultrasonographic parameters ; namely, anti-müllerian hormone (AMH) (ng/ml), follicular stimulating hormone (FSH)
(mIu/ml), peak systolic velocity (PSV) (cm/s), antral follicle count (AFC) (n), vascular index (VI) (%), flow index
(FI) (0-100), vascular flow index (VFI) (0-100), calculated ovarian age [OvAge (year)] and ovarian volume. Ancillary
outcomes were surgical feasibility and surgical consequences.
Results: 102 women completed the one-year follow up (85%), 50 in the BTS group and 52 in the BPS group and
there were no statistically significant differences regarding the ovarian reserve parameters at one year post-sterilization
including AMH, FSH, AFC, VI, FI, VFI OvAge and ovarian volume (P > 0.05). Also, there were no statistically significant
differences regarding items included in surgical. consequences comparison (P > 0.05) as well as surgical sterilization
feasibility (100% vs 100%, p = 1). Also, there were no apparent complications due to sterilization procedures in both
groups.
Conclusion: Impacts of bilateral total salpingectomies (BTS) on ovarian reserve as sterilizing procedure during cesarean
section as well as rates of surgical consequences are similar with that of bilateral partial salpingectomies (BPS) (STL). So,
BTS could be recommended over BPS (STL) for women completing their reproductive desire, despite its better efficacy
as ovarian cancer reducing surgery as well as its better clinical and sterilizing efficacy remained to be elucidated.
more effective ovarian cancer (OvCa) risk-reducing primary prevention and bilateral partial salpingectomy (BPS) [stander
tubal ligation (STL)] procedures at time of cesarean section (CS) for parturients who completed their reproductive desire
and requesting permanent sterilization regard to the impacts of both procedures on ovarian reserve parameters at one year
post-sterilization as well as the surgical consequences of both procedures.
Patients and Methods: This is a prospective, randomized, open-label, concealed allocation, parallel group, superiority
trial was conducted at three surgical sites in El-Qulobia, Egypt including Benha University Hospital, Obstetrics and
Gynecology Department between October 2015 and October 2017. 120 parturients undergoing CS were allocated to
BTS (intervention group) (60) and BPS (control group) (60). Main outcomes were one year post-sterilization differences
in ovarian reserve (OR) parameters including hormonal as well as two-dimensional and three-dimensional transvaginal
ultrasonographic parameters ; namely, anti-müllerian hormone (AMH) (ng/ml), follicular stimulating hormone (FSH)
(mIu/ml), peak systolic velocity (PSV) (cm/s), antral follicle count (AFC) (n), vascular index (VI) (%), flow index
(FI) (0-100), vascular flow index (VFI) (0-100), calculated ovarian age [OvAge (year)] and ovarian volume. Ancillary
outcomes were surgical feasibility and surgical consequences.
Results: 102 women completed the one-year follow up (85%), 50 in the BTS group and 52 in the BPS group and
there were no statistically significant differences regarding the ovarian reserve parameters at one year post-sterilization
including AMH, FSH, AFC, VI, FI, VFI OvAge and ovarian volume (P > 0.05). Also, there were no statistically significant
differences regarding items included in surgical. consequences comparison (P > 0.05) as well as surgical sterilization
feasibility (100% vs 100%, p = 1). Also, there were no apparent complications due to sterilization procedures in both
groups.
Conclusion: Impacts of bilateral total salpingectomies (BTS) on ovarian reserve as sterilizing procedure during cesarean
section as well as rates of surgical consequences are similar with that of bilateral partial salpingectomies (BPS) (STL). So,
BTS could be recommended over BPS (STL) for women completing their reproductive desire, despite its better efficacy
as ovarian cancer reducing surgery as well as its better clinical and sterilizing efficacy remained to be elucidated.