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Bilateral Salpingo - Oophorectomy Surgery India

Definition

Unilateral salpingo-oophorectomy is the surgical removal of a fallopian tube and an ovary. If both sets of fallopian tubes and ovaries are removed, the procedure is called a bilateral salpingo-oophorectomy.


Purpose

This surgery is performed to treat ovarian or other gynecological cancers, or infections caused by pelvic inflammatory disease. Occasionally, removal of one or both ovaries may be done to treat endometriosis, a condition in which the lining of the uterus (the endometrium) grows outside of the uterus (usually on and around the pelvic organs). The procedure may also be performed if a woman has been diagnosed with an ectopic pregnancy in a fallopian tube and a salpingostomy (an incision into the fallopian tube to remove the pregnancy) cannot be done. If only one fallopian tube and ovary are removed, the woman may still be able to conceive and carry a pregnancy to term. If both are removed, however, the woman is rendered permanently infertile. This procedure is commonly combined with a hysterectomy (surgical removal of the uterus); the ovaries and fallopian tubes are removed in about one-third of hysterectomies.

Until the 1980s, women over age 40 having hysterectomies routinely had healthy ovaries and fallopian tubes removed at the same time. Many physicians reasoned that a woman over 40 was approaching menopause and soon her ovaries would stop secreting estrogen and releasing eggs. Removing the ovaries would eliminate the risk of ovarian cancer and only accelerate menopause by a few years.

In the 1990s, the thinking about routine salpingooophorectomy began to change. The risk of ovarian cancer in women who have no family history of the disease is less than 1%. Moreover, removing the ovaries increases the risk of cardiovascular disease and accelerates osteoporosis unless a woman takes prescribed hormone replacements.


Description

General or regional anesthesia will be given to the patient before the procedure begins. 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. A tube containing a tiny lens and light source (a laparoscope) is then inserted through the incision. A camera can be attached that allows the surgeon to see the abdominal cavity on a video monitor. When the ovaries and fallopian tubes are detached, they are removed though a small incision at the top of the vagina. The organs can also be cut into smaller sections and removed. 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 (10–15 cm) long into the abdomen extending either 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. A disadvantage to abdominal salpingo-oophorectomy is that bleeding is more likely to be a complication of this type of operation. The procedure is more painful than a laparoscopic operation and the recovery period is longer. A woman can expect to be in the hospital two to five days and will need three to six weeks to return to normal activities.


Diagnosis/Preparation

Before surgery, the doctor will order blood and urine tests, and any additional tests such as ultrasound or x rays to help the surgeon visualize the woman's condition. The woman may also meet with the anesthesiologist to evaluate any special conditions that might affect the administration of anesthesia. A colon preparation may be done, if extensive surgery is anticipated.

On the evening before the operation, the woman should eat a light dinner, then take nothing by mouth, including water or other liquids, after midnight.


Aftercare

If performed through an abdominal incision, salpingo-oophorectomy is major surgery that requires three to six weeks for full recovery. However, if performed laparoscopically, 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 hormone replacement therapy (HRT) may be prescribed to relieve the symptoms of surgical menopause and to help prevent heart and bone disease.

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.

Potential complications after a salpingo-oophorectomy include changes in sex drive, hot flashes, and other symptoms of menopause if both ovaries are removed. Women who have both ovaries removed and who do not take estrogen replacement therapy run an increased risk for cardiovascular disease and osteoporosis. Women with a history of psychological and emotional problems before an oophorectomy are more likely to experience psychological difficulties after the operation.


Normal results

If the surgery is successful, the fallopian tubes and ovaries will be removed without complication, and the underlying problem resolved. In the case of cancer, all the cancer will be removed. A woman will become infertile following a bilateral salpingo-oophorectomy.


Alternatives

Depending on the specific condition that warrants an oophorectomy, it may be possible to modify the surgery so at least a portion of one ovary remains, allowing the woman to avoid early menopause. In the case of endometriosis, there are a number of alternative treatments that are usually pursued before a salpingooophorectomy (with or without hysterectomy) is performed. These include excising the growths without removing any organs, blocking or destroying the nerves that provide sensation to some of the pelvic structures, or prescribing drugs that decrease estrogen levels.


Laparoscopic bilateral salpingo oophorectomy Surgery India

Laparoscopic salpingo-oophorectomy is surgery to remove one or both fallopian tubes together with the ovaries. It is also used in patients for the low risk breast cancer surgery. The ovaries are a pair of organs in the lower abdomen (stomach) that make eggs and female hormones. When one of your ovaries releases an egg, the egg passes through the tube to your uterus. The female hormones, such as estrogen and progesterone, are special chemicals which help the body work correctly. This surgery is done to remove cysts, tumors, adhesions, or blockages, and treat infections in the tubes and ovaries. It is also done in pregnancies where the fertilized egg grows outside the womb. It may be needed to stop the ovaries from making hormones that increase your risk for having breast and ovarian cancer. After surgery, you are taken to a recovery room until you are fully awake. The endotracheal tube may be removed after you are awake and can breathe well on your own. You may be able to eat when bowel sounds are heard. Bowel sounds mean that your digestive system is working. Some examples of soft foods are ice cream, applesauce, or custard. Once you can eat soft food easily, you may begin eating your usual diet.

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