Salpingo-oophorectomy

What is salpingo-oophorectomy?

A salpingo-oophorectomy is the surgical removal of the ovaries and fallopian tubes. The surgery gets its names from the two procedures involved:

• Salpingectomy: The removal of the fallopian tube or tubes.
• Oophorectomy: The removal of an ovary or the ovaries.

This article will cover:

• Why do I need a salpingo-oophorectomy?
• How is the surgery performed?
• Recovery
• Side effects

Why do I need a salpingo-oophorectomy?

A salpingo-oophorectomy may be performed to treat ovarian cancer, either alone or with a hysterectomy if the cancer has spread to the uterus or to determine the stage of the cancer. It may also be done as a preventive measure for healthy women who are at high risk of developing breast, uterine and ovarian cancer due to inherited mutations in the BRCA1 or BRCA2 genes, Lynch Syndrome or other hereditary genetic mutations.

Types of salpingo-oophorectomy

The two types of salpingo-oophorectomy are: unilateral and bilateral.

• A unilateral salpingo-oophorectomy is the surgical removal of one ovary and one fallopian tube located on the same side of the uterus and sharing a blood supply.
• A bilateral salpingo-oophorectomy removes both ovaries and fallopian tubes.

Unilateral salpingo-oophorectomy: If you plan to have children, and the cancer is confined to one side, you may be a candidate for a unilateral salpingo-oophorectomy. After you have children, doctors may recommend removing the remaining fallopian tube and ovary, as well as the uterus.

Bilateral salpingo-oophorectomy: A bilateral salpingo-oophorectomy may be done for a known cancer or may be an option to reduce the risk for ovarian and breast cancer, particularly in women with BRCA gene mutations.

Women who have certain types of ovarian masses or cysts also may also need this surgery.

A bilateral salpingo-oophorectomy leads to inability to produce one’s own eggs for future fertility and may also trigger surgical menopause. Patients undergoing this procedure should speak to their doctor about the related risks and side effects and how to manage them.

How is the surgery performed?

Open abdominal surgery: One method of performing a salpingo-oophorectomy is via open abdominal surgery. During this procedure, one or both of the fallopian tubes and ovaries are removed via an incision (vertical or horizontal) in your abdomen.

Laparoscopic surgery: Laparoscopic surgery is a minimally invasive option available to some patients undergoing a salpingo-oophorectomy. This procedure uses a smaller abdominal incision than open surgery. During this procedure, the surgeon makes a small incision in the abdominal wall around the belly button. A laparoscope (a tube containing a tiny lens, camera and light source) is then inserted through the incision, helping to guide the surgeon to the target area with the aid of images projected on a video monitor. The surgeon then detaches the ovary and fallopian tube and removes them though one of the small incisions. Patients undergoing laparoscopic surgery may have a shorter recovery time than with traditional open surgery. This minimally invasive approach may also be performed with the assistance of robotic technology.

Recovery

It may take two to six weeks to recover after an open unilateral or bilateral salpingo-oophorectomy. It’s normal to feel more tired and have less energy than normal for several weeks after surgery. As your body heals, you should begin to feel incrementally better every day. You may also experience bloating in your abdominal region, and this swelling can last for several weeks.

Follow your care team’s recovery instructions exactly to allow time to heal safely.

Below are general instructions to help you recover.

Physical activity

• Get plenty of sleep and be sure to rest when you’re feeling tired.
• Walk every day in increasing increments to help increase blood flow and prevent constipation.
• Avoid lifting heavy objects or doing strenuous exercise until your doctor clears you for such activities.
• Don’t have sexual intercourse after surgery until your doctor says it’s OK.

Diet

• Eat a bland diet if you’re experiencing nausea, but otherwise you may eat normally. Inform your care team if you are experiencing persistent nausea.
• Drink plenty of fluids and consult with your doctor if you’re experiencing constipation.

Incision care

• Wear loose clothing that doesn’t constrict your stomach or rub against your surgical wounds.
• Keep your incision site clean and dry per your doctor’s instructions.

Pain

• If your doctor prescribed pain medicine or recommended an over-the-counter product such as acetaminophen, ibuprofen or naproxen, take it as directed when needed.
• Use a heating pad on your abdominal area to ease pain.

If you undergo a laparoscopic salpingo-oophorectomy (either unilateral or bilateral), your recovery time may be shorter than after an open surgery.

• You will likely feel sore in your abdominal area for several days, and you may experience swelling and bowel movement changes.
• Because your doctor pumped air into your stomach in order to see your organs clearly, you may experience back and/or shoulder pain. This is called referred pain.
• It may take about a week for you to completely recover, during which time you should not lift heavy objects or engage in major exercises.
• Be sure to get your doctor’s consent before resuming sexual intercourse. As always, follow your care team’s specific post-operative instructions.

Side effects

After an open or laparoscopic salpingo-oophorectomy procedure (either unilateral or bilateral), you may experience some side effects. In addition to fatigue and pain, you may experience:

• Changes in bowel habits
• Changes in appetite
• Joint pain
• Muscle pain
• Insomnia
• Recurrent vaginal infections
• Incontinence
• Mood swings, irritability, depression or anxiety
• Hot flashes
• Difficulty sleeping
• Vaginal dryness
• Pain with sex and potentially loss of sexual desire

In addition, if the patient's lymph nodes are removed as part of the surgery, she may experience a side effect called lymphedema. This occurs when lymph fluid builds up in the soft body tissues, resulting in swelling.

Learn more about lymphedema treatment for gynecologic cancers.

If you experience any of the below serious side effects with either type of salpingo-oophorectomy, seek medical attention immediately:

• Pain that doesn’t improve even with pain medication
• Extreme constipation (you cannot pass a bowel movement or gas)
• Foul-smelling vaginal discharge or an increased amount of vaginal discharge
• Nausea and the inability to keep fluids down
• Loose stitches at the incision site, or an open incision site
• Bright-red blood that seeps through your incision site bandage
• Signs of infection, including fever, warmth/redness/swelling, red streaks and/or pus at the incision site
• Symptoms of a blood clot such as pain, redness and/or swelling in the calf/leg