Effect of bilateral salpingectomy on ovarian reserve in patients undergoing hysterectomy for benign conditions

Hysterectomy is one of the most frequently performed operations. Addition of bilateral salpingo-oophorectomy during hysterectomy operation to avoid possible future adnexal pathologies can affect these women's quality of life especially women in premenopausal period. In recent studies, it is stated that serous ovarian carcinomas can be originated from tubal fimbriae. Performing salpingectomy during hysterectomy can prevent serous ovarian carcinomas. Nevertheless, ovarian reserve which would be already affected adversely during hysterectomy operation, could be more deteriorated by salpingectomy. There are not many randomized controlled studies exist in literature evaluate the effect of additional salpingectomy in ovarian reserve in patients who will undergo hysterectomy for benign reasons. We aimed to evaluate the effect of salpingectomy on ovarian reserve in patients undergoing hysterectomy. Method: Patients who were admitted to Ege University Faculty of Medicine Hospital and indicated hysterectomy for benign reasons were included in the study. Our study is a randomized, prospective analytical study. Patients who were performed salpingectomy were included in group 1, the others were included in group 2. Randomization was performed by the sealed envelope method. Patients were performed ovarian reserve tests before the operation, 6 week and 6 months after the operation. Anti Müllerian Hormone and ovarian ultrasonographic evaluation (antral follicle count, 3dimentional ovarian volume evaluation) and ovarian stromal blood flow doppler ultrasonographic evaluation (peak systolic velocity, Pulsatility index. Resistance index, Sistol/diastole) were performed. The results were evaluated by comparing not only between groups but also within the group. Results: Sixty three patients were included in the study. Thirty four patients were performed salpingectomy (Group 1), and rest were Group 2. Two groups had similar VII data in terms of age, body mass index, duration of surgery, gravida, parity and intraoperative blood loss. There was no significant difference in both groups compared in the light of this data. AMH values were compared due to three controls and there were no significant difference between groups. The pre-operative and post-operative values of AMH were compared within the group, AMH levels were statistically decreased. Ovarian ultrasonographic evaluation were performed in 27 patients in group 1 and 18 patients in group 2. Ovarian volume and AFC were compared between groups and no statistically difference were determined. Ovarian blood flow doppler ultrasonography datas were (PSV, PI, RI, S/D) evaluated in all controls and only 4 of 24 parameters were significantly differed between groups. Conclusion: Our study determined that prophylactic salpingectomy in hysterectomy does not affect ovarian reserve adversely compared with the women who did not performed salpingectomy. Due to recent data, patients who will undergo hysterectomy for benign reasons, can be recommended additional salpingectomy after explanation of the benefit and harm of this operation and obtained consult. Due to the small number of patients in our study, to evaluate the protective effect of salpingectomy on ovarian cancer, prospective, randomized population based studies are needed.