Feasibility of bilateral salpingo-oophorectomy during vaginal hystertectomy for benign uterine diseases

ABSTRACT

Background: Prophylactic bilateral salpingo-oophorectomy (BSO) remains the best measure in the prevention of ovarian cancer as it lacks an effective screening tool. The need to perform prophylactic BSO shouldn't dictate the route of surgery. To assess the feasibility of prophylactic BSO during vaginal hysterectomy. To analyze the safety of the vaginal BSO.Methods: This was a retrospective study conducted in the Department of Obstetrics and Gynaecology at Velammal Medical College, Madurai, Tamilnadu, India from June 2016 to June 2018 over a period of 3 years. 54 women who underwent hysterectomy for benign uterine disease in whom concomitant prophylactic BSO was attempted were included in the study. Preoperative data like age, parity, menopausal status, BMI, previous pelvic surgeries were noted from the admission record. Intraoperative details like indication for surgery, surgical procedure, duration of surgery and complications like hemorrhage, bladder, ureter and bowel injury were collected from the operative record. Postoperative recovery details were also noted down from the case sheet. The collected data were then analyzed.Results: Of the 54 women included in the study, transvaginal BSO was successful in 53 (98.1%) women. There was one case of primary haemorrhage due to slippage of ovarian pedicle, another patient required laparotomy for completing BSO. None had bladder, ureter or bowel injury.Conclusions: Prophylactic BSO is both feasible and safe in almost all patients undergoing vaginal hysterectomy. Developing the skill to perform transvaginal BSO can inspire gynaecologists to move a step forward and deal with benign adnexal pathology concomitantly at vaginal hysterectomy. The risk of remnant ovarian syndrome post vaginal oophorectomy is unknown.