Subramaniam A, et al. - A randomized controlled trial was performed to assess the feasibility of salpingectomy compared with standard bilateral tubal ligation at the time of cesarean delivery in women with undesired fertility. Researchers reported that adding 15 minutes to total operative times, salpingectomy could be effectively completed in approximately two-thirds of women wanting permanent contraception with cesarean delivery.

Methods

• Study participants were women at 35 weeks of gestation or greater desiring permanent sterilization at the time of cesarean delivery.
• By a computer-generated scheme, patients were randomized after skin incision to bilateral salpingectomy or bilateral tubal ligation.
• Bilateral tubal ligation was attempted if salpingectomy could not be completed on one or both sides.
• Total operative time and bilateral completion of the randomized procedure were the primary feasibility outcomes.
• Clinically estimated blood loss and surgical complications up to 6 weeks postpartum were the included secondary outcomes.
• Researchers assessed that 80 subjects (40 per group) would provide greater than 80% power to identify a 10-minute difference in the primary outcome (time) with an SD of 15 minutes and a two-sided α of 0.05.
• Analysis was by intent to treat.

Results

• From June 2015 to April 2017, out of 221 women screened, 115 (52%) consented to the study; 80 were randomized—40 to salpingectomy and 40 to bilateral tubal ligation.
• At baseline, groups were similar.
• It was observed that 27 bilateral salpingectomies were successfully completed compared with 38 bilateral tubal ligations (68% compared with 95%, P=.002).
• It was noted that total operative time was on average 15 minutes longer for salpingectomies (75.4±29.1 compared with 60.0±23.3 minutes, P=.004).
• In either group, no adverse outcomes directly related to the sterilization procedure were noted.
• The study results showed that although estimated blood loss of only the sterilization procedure (surgeon estimate) was greater for the salpingectomy group (median 10 [interquartile range 5–25] compared with 5 [interquartile range 5–10] cc, P < .001), total estimated blood loss and safety outcomes were similar for both groups.