While the fallopian tubes are crucial for female fertility, as we covered at length in our fallopian tubes primer, there are some cases when surgical removal of the tubes may be recommended. Sometimes, conditions can be treated by a salpingostomy, or a small incision into the fallopian tubes. Other times, complete surgical removal of the fallopian tube—or salpingectomy—is needed. Here we also briefly cover the most common fallopian tube surgery, a permanent female sterilization procedure called tubal ligation.
Salpingectomy to reduce ovarian cancer risk
Women who have a BRCA1 or BRCA2 mutation may consider getting their fallopian tubes and ovaries removed. These are genetic mutations that are known to increase your risk of breast, ovarian, and fallopian tube cancers. But how would you know if you have one or both of these mutations? If you have a close relative with breast cancer or personal history of breast cancer, you may be offered genetic testing for BRCA1/2 mutations.
In women with a BRCA1 or BRCA2 mutation et one additional genetic mutation, or in young women with either a BRCA1 or BRCA2 mutation, a salpingectomy (tube removal) is recommended to reduce the risk of ovarian cancer [1]. The risk of developing ovarian cancer by age 70 if you have BRCA1 is 40-60% (another research study puts the estimates lower, at 39%-46% risk) and 11-27% if you have BRCA2 [1][2].
Should you also have an oophorectomy to reduce ovarian cancer risk if you have BRCA 1 or BRCA2?
Historically, women determined to be at high risk of hereditary ovarian and breast cancer (HBOC) were recommended to undergo preventative removal of both ovaries et both fallopian tubes either a) when the woman had finished childbearing, b) by age 35-40, or c) 10 years before the age of diagnosis of a close relative diagnosed with ovarian cancer. But reality has not matched recommendations, as “it is believed that the majority of these high-risk women do not undergo (risk-reducing salpingo-oophorectomy) by age 40” [1]. This is in part because removal of the ovaries puts young women into surgically-induced menopause, with attendant risks of cardiovascular problems, impaired sexual function, osteoporosis, cognitive impairment, and higher likelihood of death in general.
Fortunately, recent research has allowed the National Comprehensive Cancer Network to more narrowly target its recommendations. Epithelial ovarian cancer is the most common type of ovarian cancer. Researchers now have evidence that the most common and aggressive subtype of epithelial ovarian cancer, high-grade serous carcinoma (as well as, to a lesser extent, epithelial ovarian cancer subtype low-grade serous carcinoma), actually develops in the trompe de Fallope epithelium [1]. Thus, young women with known BRCA mutations may choose to have only their fallopian tubes removed after childbearing is complete, with the potential to remove the ovaries at a later date. The major benefit of this approach is that the young woman does not go into early menopause [1].
Researchers note that removal of the fallopian tubes alone should also reduce risk of epithelial ovarian cancer subtypes clear cell and endometriosis-related ovarian cancer, in addition to the high-grade serous carcinoma and low-grade serous carcinoma subtypes [1].
Salpingectomy to treat tubal ectopic pregnancy
In the case of a tubal ectopic pregnancy (the most common type of grossesse extra-utérine), surgical removal of the entire fallopian tube is sometimes required. This depends on the location of the embryo and/or extent of damage to the fallopian tube [3]. Other times, a salpingostomy (an incision in the tube) can remove the ectopic pregnancy et preserve the fallopian tube for future fertility.
Finally, when a fallopian tube is filled with too much fluid or is severely infected, surgical removal may also be necessary for complete treatment.
How does salpingectomy affect fertility?
While removing the fallopian tubes typically has minimal or no effect on female hormone levels (unlike removing the ovaries), it peut result in reduced fertility (or infertility if both tubes are removed). It’s important to discuss fertility goals, cancer risk, and overall health with a doctor if you’re considering fallopian tube removal.
Tubal ligation
Tubal ligation is a form of permanent contraception, also called female sterilization. It is typically performed laparoscopically, or through an abdominal incision. While a salpingectomy refers to removal of the fallopian tubes, tubal ligation may refer to cutting, tying, clipping cauterizing, or completely removing the tubes.
Tubal ligation is not without side effects, some of which (like post-tubal ligation syndrome) can be quite severe, and include painful periods, PMS- and menopause-like symptoms, migraines, and risk of a (non-tubal) ectopic pregnancy (should fertilization still occur, and La recherche suggère that this rare occurrence may happen more often than previously believed!).
For women who seek effective pregnancy prevention options without the side effects of tubal ligations, les méthodes de sensibilisation à la fertilité and can be an empowering option for couples seeking to avoid pregnancy indefinitely or permanently. And for women or couples who change their minds about their family size being complete, tubal ligation reversal surgery has relatively high success rates.
Le bilan
Salpingectomy, the removal of your fallopian tubes, may be recommended to treat an ectopic pregnancy or to reduce ovarian cancer risk in premenopausal women with a certain genetic mutation and a family history of breast and/or ovarian cancer. Tubal ligation, a female sterilization procedure intended to be permanent, may prevent conception through manipulation of the fallopian tubes or their removal altogether, but it is not without the potential for les effets secondaires and, for some, regret. However, there are alternatives to sterilization that allow both men and women to keep their reproductive systems intact (and you can read about them ici).
Références :
[1] George SH, Garcia R, Slomovitz BM. Ovarian Cancer: The Fallopian Tube as the Site of Origin and Opportunities for Prevention. Front Oncol. 2016 May 2;6:108. doi: 10.3389/fonc.2016.00108. PMID: 27200296; PMCID: PMC4852190. [2] Holman LL, Friedman S, Daniels MS, et al. Acceptability of prophylactic salpingectomy with delayed oophorectomy as risk-reducing surgery among BRCA mutation carriers. Gynecol Oncol. 2014 May;133(2):283-6. doi: 10.1016/j.ygyno.2014.02.030. Epub 2014 Feb 28. PMID: 24582866; PMCID: PMC4035022. [3] Yeung, P., Mohan, A., & Gavard, J. “The Long-term Rate of Repeat Surgery After Optimal Excision Surgery of Endometriosis at a Single Tertiary Referral Center.” Preprints.(2024) https://doi.org/10.20944/preprints202409.1485.v1. *Pre-print study that has not yet been peer reviewed.
