Salpingectomy versus tubal ligation for sterilization: a systematic review and meta-analysis

Kerry Mills, Greg Marchand, Katelyn Sainz, Ali Azadi, Kelly Ware, Janelle Vallejo, Sienna Anderson, Alexa King, Asya Osborn, Stacy Ruther, Giovanna Brazil, Kaitlynne Cieminski, Sophia Hopewell, Lisa Rials, Angela Klipp
American Journal of Obstetrics and Gynecology 2020 September 14

OBJECTIVE: Following strong evidence and major organizations recommending salpingectomy over tubal ligation, we sought to perform a systematic review and meta-analysis comparing the intraoperative attributes and complication rates associated with these two procedures.

DATA SOURCES: We searched PubMed, the Cochrane Library, EMBASE and clinical trials registries without time or language restrictions. The search was carried out in February 2020. Database searches revealed 74 potential studies, of which 11 were examined at the full-text level. Of these, six studies were included in the qualitative analysis and five studies were included in the meta-analysis.

STUDY ELIGIBILITY CRITERIA: We included randomized controlled trials comparing salpingectomy with tubal ligation in women seeking sterilization. We included studies that also had at least one outcome listed in the PICOTS. Articles were excluded if they did not meet the inclusion criteria or if data were not reported and the authors did not respond to inquiries.

STUDY APPRAISAL AND SYNTHESIS METHODS: Abstracts and full-text articles were assessed by two authors independently using the blinded coding assignment function or EPPI-Reviewer 4. Conflicting selections were resolved by consensus. The quality of included studies was determined using the Cochrane Collaboration tool for assessing the risk of bias in randomized trials. Two authors independently assessed the risk of bias for each study; disagreements were resolved by consensus.

RESULTS: There were few differences between the procedures, with no differences in most important clinical outcomes (AMH, blood loss, length of hospital stay, pre- or post-operative complications, or wound infections). A single study reported a reduced rate of pregnancies with salpingectomy (RR = 0.22, 95% CI: 0.05, 1.02), but this did not reach statistical significance (p = 0.05).

CONCLUSIONS: We conclude from these data that salpingectomy is as safe and efficacious as tubal ligation for sterilization, and may be preferred, where appropriate, to reduce the risk of ovarian cancer.

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