Skip to main content

Clinician

Blog articles for clinicians and other medical professionals.

Clinical Overview of Salpingectomy and Risks Involved

August 18th, 2025

Definition and indications

Salpingectomy is the surgical removal of one (unilateral) or both (bilateral) fallopian tubes. It is indicated in a variety of clinical situations, including the management of ectopic pregnancies, permanent sterilization, reduction of ovarian cancer risk, treatment of tubal pathology such as hydrosalpinx or endometriosis, and in cases involving tubal or ovarian malignancy.

In the context of ectopic pregnancy, especially when located in the fallopian tube, salpingectomy is often the definitive treatment to remove the site of implantation and prevent life-threatening hemorrhage. For patients with recurrent or high-risk ectopic pregnancies, salpingectomy may be the preferred surgical approach to eliminate the affected tube entirely.

The procedure also plays a pivotal role in ovarian cancer prevention. High-grade serous carcinomas, the most lethal subtype of ovarian cancer, are now understood to frequently originate in the fimbrial end of the fallopian tubes.

As a result, prophylactic or opportunistic bilateral salpingectomy is increasingly recommended for individuals undergoing pelvic surgery who aren’t planning future pregnancies.

In cases of endometriosis, salpingectomy may be indicated when disease involvement leads to chronic inflammation, tubal distortion, or hydrosalpinx formation, which can exacerbate pelvic pain and infertility. Removing the affected tube can provide symptomatic relief and reduce the risk of disease recurrence.

A unilateral salpingectomy may be performed in response to a specific condition affecting one tube, while bilateral salpingectomy is often chosen for elective sterilization or opportunistic risk reduction for gynecologic malignancies.

Surgical technique

Salpingectomy can be performed using various surgical approaches, with laparoscopic surgery being the most common. This minimally invasive method involves placing small ports in the abdomen and using camera guidance to remove the fallopian tubes. Open laparotomic surgery may be necessary in emergency settings or in cases involving extensive adhesions or large adnexal masses.

Additionally, salpingectomy can be performed at the time of cesarean section, particularly in people desiring sterilization. The procedural steps typically include general anesthesia, identification of the fallopian tubes, coagulation of mesosalpinx vessels, and transection of the tube from the uterine cornua. The tube is removed from the abdomen, and the surgical field is inspected for hemostasis before closing the incisions.

Benefits

Salpingectomy offers several clinical benefits. As a form of permanent contraception, it is nearly 100% effective in preventing natural conception, offering slightly higher efficacy than tubal ligation.

It also significantly reduces the risk of high-grade serous ovarian carcinoma, which is thought to originate in the fimbrial portion of the fallopian tube. For this reason, many professional societies now recommend opportunistic salpingectomy during pelvic surgeries for individuals who have completed childbearing.

Furthermore, it is a definitive treatment for tubal diseases such as hydrosalpinx, chronic pelvic infections, and ectopic pregnancy. Hydrosalpinx refers to a condition where the fallopian tube becomes blocked and filled with a clear or serous fluid, typically as a result of prior infection, inflammation, or tubal surgery. This distension and accumulation of fluid not only impairs the natural function of the tube but also releases inflammatory mediators that can negatively affect the endometrial environment.

In the context of assisted reproductive technologies like in vitro fertilization (IVF), the presence of a hydrosalpinx has been shown to significantly reduce implantation and pregnancy rates. Salpingectomy in these cases removes the affected tube, eliminating the source of inflammatory fluid and improving the uterine environment, thereby enhancing the success rates of IVF. It also alleviates associated pelvic pain and reduces the risk of recurrent pelvic infections.

Risks and complications

Like any surgical procedure, salpingectomy carries risks. Intraoperative complications can include bleeding from mesosalpinx vessels, and rare injuries to surrounding structures such as the ureters or intestines. In some cases, the surgery may need to be converted from laparoscopic to open due to unforeseen anatomical difficulties.

Postoperatively, patients may develop infections, thrombosis, or experience localized or referred pain, such as shoulder tip discomfort from residual pneumoperitoneum. When compared to tubal ligation, studies show no significant differences in complication rates, surgical blood loss, or impact on hormone levels.

While salpingectomy can add about seven minutes to the operative time, hospital stays, and postoperative recovery are comparable.

Fertility and pregnancy after procedure

The ability to conceive naturally after salpingectomy depends on whether one or both fallopian tubes are removed. In bilateral salpingectomy, natural conception is impossible, as the ova cannot reach the uterus.

However, rare cases of pregnancy have been reported post-bilateral salpingectomy, though these are exceedingly uncommon, with false positive pregnancy tests accounting for the majority. With unilateral salpingectomy, patients may still conceive naturally using the remaining tube, and studies show comparable conception rates to tubal ligation.

The risk of ectopic pregnancy in the removed tube is eliminated, but pregnancies that occur post-sterilization still carry a higher risk of being ectopic. Assisted reproductive technologies, particularly IVF, are the only viable option for achieving pregnancy after bilateral salpingectomy.

Comparative summary

When comparing salpingectomy and tubal ligation, several important distinctions emerge. Salpingectomy offers a slightly higher rate of contraceptive efficacy and significantly reduces the risk of ovarian cancer. It is irreversible, unlike tubal ligation, which may be reversible in select cases.

While operative times may be marginally longer with salpingectomy, the procedure does not add additional recovery time or significant risk. Importantly, tubal ligation is associated with a higher risk of ectopic pregnancy if failure occurs.

Conversely, salpingectomy nearly eliminates this risk, especially when both tubes are removed. Reproductive options post-procedure also differ. Those undergoing bilateral salpingectomy must use IVF to achieve pregnancy, whereas those who have had tubal ligation may consider tubal reversal or, if pregnancy occurs, are at risk for ectopic implantation.

Recovery and patient experience

Recovery following salpingectomy is typically straightforward. For laparoscopic procedures, most patients can resume light activity within one to two days, with full recovery expected in two to four weeks. Recovery from open procedures may take four to six weeks.

In cases where salpingectomy is performed during cesarean delivery, recovery mirrors the usual postpartum course. Patients should be counseled on pain control, signs of infection, and advised to avoid heavy lifting and sexual intercourse for a few weeks.

Psychologically, the permanence of salpingectomy should be emphasized during preoperative counseling, especially in patients under age 30 or those who are childless, as these populations are at higher risk for sterilization regret. Alternative long-acting reversible contraceptives or male sterilization may also be discussed during this counseling process.

Clinical pearls

Clinicians should ensure thorough preoperative preparation, including patient fasting, review of imaging and medications, and obtaining informed consent. Clear discussion regarding the irreversible nature of the procedure and reproductive implications is essential.

Intraoperatively, attention to hemostasis and proper technique in the cornual region can reduce the risk of complications. Surgeons should inspect the contralateral adnexa for incidental pathology and document all findings and decisions.

When appropriate, opportunistic bilateral salpingectomy should be considered in eligible those undergoing pelvic surgery for benign indications.

Recommendations and guidelines

Professional organizations such as the Ovarian Cancer Research Alliance now advocate for opportunistic bilateral salpingectomy as a risk-reducing strategy for ovarian cancer in individuals who have completed childbearing.

Evidence from randomized studies and meta-analyses shows that salpingectomy is as safe and effective as tubal ligation, with added oncologic benefit. When performed during cesarean delivery, it has been shown to be a cost-effective and efficient strategy with minimal added risk. These guidelines support broader implementation of salpingectomy over ligation in appropriate clinical settings.

Overview and recap

Salpingectomy is a safe, effective surgical method for permanent contraception and significantly reduces the risk of ovarian cancer. It is appropriate for patients desiring sterilization, treatment of tubal pathology, or those undergoing pelvic surgery for other indications.

When bilateral salpingectomy is performed, patients must be counseled on the need for IVF for any future pregnancies. The procedure offers a complication profile similar to tubal ligation but has superior long-term benefits in terms of contraceptive efficacy and cancer risk reduction.

Clinicians must ensure thorough preoperative counseling, proper surgical technique, and individualized patient care to optimize outcomes.

References