Salpingectomy vs Tubal Ligation for Sterilization: A Systematic Review and Meta-analysis

The association between removal of the fallopian tubes and decreased risk of ovarian cancer is well documented. Although complete removal of the fallopian tubes (salpingectomy) for the prevention of ovarian cancer seems promising, no unequivocal evidence supports this practice in women seeking sterilization. Several investigators have described methods of minimally invasive interruption of the fallopian tubes (tubal ligation) without requiring complete removal. Routine salpingectomy has been performed at the time of removal of the ovaries with hysterectomy, but was rarely performed for the purpose of sterilization before the American College of Obstetricians and Gynecologists published Committee Opinion Number 620 in 2015. There has been a trend in recent years toward "opportunistic" salpingectomy to decrease risk of ovarian cancer. It is now generally accepted that salpingectomy is the preferred method of sterilization inmost cases; however, clinical concerns and reimbursement barriers have impeded universal consensus in the United States that salpingectomy is preferable to tubal ligation. The aim of this systematic review and meta-analysis was to identify, appraise, and summarize available data from randomized control trials that compare the efficacy, safety, and complications of salpingectomy and tubal ligation. An electronic search of PubMed, the Cochrane Library, Embase, and clinical trials registries databases was conducted in February 2020. There were no time or language restrictions. Studies were excludedwhich did not meet inclusion criteria, had unreported data, or whose authors did not respond to inquiries. Two authors independently assessed abstracts and full-text articles using the blinded coding assignment function or systematic review software. Selection conflicts were resolved by consensus. The Cochrane Collaboration tool for assessing the risk of bias in randomized trials was used to determine the quality of included studies. The risk of bias for each study was independently assessed by 2 authors; disagreements were resolved through consensus. The initial search identified 74 potential studies, 11 of which were examined at the full-text level. Six of the 11 studies were included in the qualitative analysis and 5 in the meta-analysis. The quality of the studies included was mostly good, with most displaying low risk of bias from randomization, allocation concealment, or selective reporting. Few differences between safety and complication rates in the 2 procedures were noted. There were no differences for most important clinical outcomes (antimullerian hormone, blood loss, length of hospital stay, preoperative or postoperative complications, or wound infections). In a single study, a reduced rate of pregnancies with salpingectomy was reported (risk ratio, 0.22; 95% confidence interval, 0.05-1.02), but the difference did not reach statistical significance (P < 0.05). The relatively small sample size and number of outcomes reported limited the quantity and quality of data comparing these 2 procedures. These data showthat salpingectomy is as safe and efficacious as tubal ligation for sterilization. The additional potential benefits of decreased risk of ovarian cancer suggest that salpingectomy may become the preferred method for voluntary sterilization in the future. In light of the limited evidence identified in this systematic review, additional high-quality studies are needed to provide evidence on the relative risk of adverse events for salpingectomy and tubal ligation.