Bilateral Salpingectomy
The procedure where the fallopian tubes are removed while leaving the ovaries and uterus intact is called bilateral salpingectomy. 1
Terminology and Procedure Definition
Bilateral salpingectomy refers specifically to the complete removal of both fallopian tubes, including the proximal isthmus but not the interstitial portion, while preserving the ovaries and uterus 1
This procedure is distinct from bilateral salpingo-oophorectomy (BSO), which removes both the fallopian tubes AND ovaries 2, 3
When performed during hysterectomy, the procedure is called hysterectomy with bilateral salpingectomy (removing uterus and tubes, preserving ovaries) 4
Clinical Context and Applications
Opportunistic Salpingectomy
Opportunistic (or prophylactic) salpingectomy is the term used when fallopian tubes are removed during surgery planned for other reasons, with the goal of ovarian cancer risk reduction 5, 6
This approach is increasingly recommended by gynecological societies at the time of hysterectomy or as a sterilization method in appropriate women 7, 6
The procedure can be performed during various pelvic surgeries, including hysterectomy for benign conditions, with the intent of reducing future ovarian cancer risk 4, 6
Rationale for the Procedure
High-grade serous ovarian cancers are now understood to originate predominantly in the fallopian tubes, particularly the fimbrial region, rather than the ovarian surface 7, 8
Removing the fallopian tubes eliminates the site where serous tubal intraepithelial carcinomas (STICs) develop, which are precursors to many ovarian cancers 5, 8
There is no known physiological benefit to retaining post-reproductive fallopian tubes, as their removal does not affect ovarian hormone production 8
Important Distinctions
Bilateral salpingectomy alone does NOT provide the same cancer risk reduction as bilateral salpingo-oophorectomy in high-risk populations (such as BRCA carriers), where BSO reduces ovarian cancer risk by 80-90% 2, 9
For BRCA1/2 carriers, salpingectomy alone is not recommended as standard of care and should only be considered as a temporizing measure in premenopausal patients not yet ready for oophorectomy 9
The procedure preserves ovarian function and avoids premature menopause, which is particularly important in premenopausal women 4, 8