Impact of bilateral total salpingectomy versus standard tubal ligation at time of cesarean section on ovarian reserve: A randomized controlled trial

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. .