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Dr. Kartik Venkatesh

For women seeking permanent sterilization as well as ovarian-cancer risk reduction at time of cesarean delivery, tubal ligation is still the best option, according to newly published research from the UNC Department of Obstetrics and Gynecology.

Kartik K. Venkatesh, MD, PhD, fellow in the Division of Maternal-Fetal Medicine is lead author of the paper, “Cost-effectiveness of opportunistic salpingectomy vs tubal ligation at the time of cesarean delivery,” which was published in the January 2019 issue of the American Journal of Obstetrics and Gynecology. Other UNC OB-GYN authors on the paper are Leslie Clark, MD, assistant professor in the Division of Gynecologic Oncology, and David Stamilio, MD, MSCE, professor in the Division of Maternal-Fetal Medicine.

Salpingectomy, a surgical procedure where both fallopian tubes are removed to decrease a woman’s lifetime risk of ovarian cancer, has increasingly become common clinical practice in gynecologic surgery at the time of hysterectomy or sterilization. While tubal ligation also substantially decreases ovarian cancer risk, it is slightly less effective than salpingectomy. As more women are undergoing permanent sterilization at the time of cesarean delivery, Venkatesh and his team conducted a cost-effectiveness analysis to better assess the risks and benefits of salpingectomy versus tubal ligation after cesarean delivery.

The team found that both surgical procedures were cost-effective strategies for permanent sterilization and ovarian cancer risk reduction. However, research on the safety of salpingectomy during a cesarean section is lacking, conducted only in small clinical trials with fewer than 100 women.

“There is increasing data from large cohorts of women to support this practice during a hysterectomy, suggesting that this surgical procedure does not pose an increased risk of complications. But, salpingectomy at or after the time of delivery is another question. Though salpingectomy would likely be just as effective at preventing ovarian cancer, the safety of this procedure with cesarean is not known.”

Until more data is available, Venkatesh recommends tubal ligation, and not salpingectomy, as the preferred approach for sterilization during cesarean delivery. The risk of complications of salpingectomy needs to be better defined before it can be the recommended method for sterilization during a cesarean section.