Salpingo-oophorectomy

Definition
The surgical removal of a fallopian tube and an ovary.

Purpose
This surgery is performed to treat ovarian or other gynecological cancers, or infections as a result of pelvic inflammatory disease. Occasionally, removal of one or both ovaries may be done to treat endometriosis. If only one tube and ovary are removed, the woman may still be able to conceive and carry a pregnancy to term.

Description
If the procedure is performed through a laparoscope, the surgeon can avoid a large abdominal incision and can shorten recovery. With this technique, the surgeon makes a small cut through the abdominal wall just below the navel. When the laparoscope is used, the patient can be given either regional or general anesthesia; if there are no complications, the patient can leave the hospital in a day or two.

If a laparoscope is not used, the surgery involves an incision 4-6 in (10-long into the abdomen either extending vertically up from the pubic bone toward the navel, or horizontally (the “bikini incision”) across the pubic hairline. The scar from a bikini incision is less noticeable, but some surgeons prefer the vertical incision because it provides greater visibility while operating.

Preparation
A spinal block or general anesthesia may be given before surgery.

Aftercare
If performed through an abdominal incision, salpingo-oophorectomy is major surgery that requires three to six weeks for full recovery. However, if performed laparascopically, the recovery time can be much shorter. There may be some discomfort around the incision for the first few days after surgery, but most women are walking around by the third day. Within a month or so, patients can gradually resume normal activities such as driving, exercising, and working.

Immediately following the operation, the patient should avoid sharply flexing the thighs or the knees. Persistent back pain or bloody or scanty urine indicates that a ureter may have been injured during surgery.

If both ovaries are removed in a premenopausal woman as part of the operation, the sudden loss of estrogen will trigger an abrupt premature menopause that may involve severe symptoms of hot flashes, vaginal dryness, painful intercourse, and loss of sex drive. (This is also called “surgical menopause.”) In addition to these symptoms, women who lose both ovaries also lose the protection these hormones provide against heart disease and osteoporosis many years earlier than if they had experienced natural menopause. Women who have had their ovaries removed are seven times more likely to develop coronary heart disease and much more likely to develop bone problems at an early age than are premenopausal women whose ovaries are intact.

For these reasons, some form of estrogen replacement therapy (ERT) may be prescribed to relieve the symptoms of surgical menopause and to help prevent heart and bone disease.

In addition, to help offset the higher risks of heart and bone disease after loss of the ovaries, women should get plenty of exercise, maintain a low-fat diet, and ensure intake of calcium is adequate.

Reaction to the removal of fallopian tubes and ovaries depends on a wide variety of factors, including the woman’s age, the condition that required the surgery, her reproductive history, how much social support she has, and any previous history of depression. Women who have had many gynecological surgeries or chronic pelvic pain seem to have a higher tendency to develop psychological problems after the surgery.

Risks
Major surgery always involves some risk, including infection, reactions to the anesthesia, hemorrhage, and scars at the incision site. Almost all pelvic surgery causes some internal scars, which, in some cases, can cause discomfort years after surgery.

Key Terms:

Androgens
Hormones (specifically testosterone) responsible for male sex characteristics.

Endometriosis
A painful disease in which cells from the lining of the uterus (endometrium) aren’t shed during menstruation, but instead attach themselves to other organs in the pelvic cavity. The condition is hard to diagnose and often causes severe pain as well as infertility.

Fallopian tubes
Tubes that extend from either end of the uterus that convey the egg from the ovary to the uterus during each monthly cycle.

Ureter
The tube that carries urine from the bladder to the kidneys.

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