Salpingo-oophorectomy

1. Salpingo-oophorectomy is a surgical procedure to remove one or both of the ovaries and fallopian tubes. The process of removing the ovaries is called Oophorectomy, and the surgical process of removing the fallopian tube is called Salpingectomy. After the surgery, you may need hormone replacement therapy and may enter into menopause. The surgery is carried out to treat a variety of conditions, mainly ovarian and fallopian cancer. It can also be used as a permanent method for birth control. It is of 2 types which are:
2. Bilateral Salpingo-oophorectomy in which both the ovaries along with fallopian tubes are removed. In this, you will not be able to conceive after the surgery.
3. Unilateral Salpingo-oophorectomy in which one ovary and one fallopian tube are removed. The doctor will recommend unilateral surgery when there are indications of ovarian cysts , abscess in the ovary or confirmed diagnosis for certain types of cancer in ovaries and fallopian tubes. It can also be used to lower the risk for cancer in these parts of the body. This is because a unilateral salpingo-oophorectomy lowers your estrogen levels.

Benefits of the Procedure

1. The advantage of salpingo-oophorectomy is that it avoids the risk of ovarian cancer and surgery. Especially in BRCA-positive patients and with a family history of ovarian/breast cancer, in which the lifetime risk of ovarian cancer is around 20-50%, prophylactic salpingo-oophorectomy may be considered.
2. The procedure reduces the risk of BRCA-associated gynaecological cancer by 80-96%. Laparoscopic salpingo-oophorectomy has fewer complications and lesser hospitalization

The salpingo-oophorectomy is performed to treat a variety of conditions such as:

1. ovarian cancer
2. Benign tumour
3. High-risk cysts in the ovary, endometriosis
4. Ovarian torsion (in which the ovary and tube are necrotic, a tubo ovarian abscess is not responsive to antibiotics, or a benign ovarian mass is present, in which there is no normal ovarian tissue could be conserved)
5. Abscess and in case of  ruptured ectopic pregnancy. 
6. It also lowers the risk of cancer (breast and ovarian) in women who carry BRCA gene mutations which have a high risk of developing cancer. 
7. Pelvic  inflammatory disease (PID) or Tubo ovarian torsion

What to expect before the Surgery?

The doctor will perform some imagining tests to produce detailed images of the inside of the uterus. The surgeon will recommend you not to eat or drink anything after midnight a day before the surgery. The doctor may also ask you to stop taking a blood thinner (if you are any) a week before the surgery. Kindly reach the hospital at least 2 hours before the day of the surgery. Also, you will be under Anesthesia at the time of the surgery, so kindly arrange for the ride back home after the surgery.

What to expect on the day of Surgery?

Once you reach the hospital, the doctor will ask you to sign the consent form to allow them to perform the surgery. The doctor will ask you to remove the jewellery, dentures, or hearing aids (if any) before the surgery. Then you need to change into a hospital gown. Once done, you will be taken to the operation theatre room. 

Procedure

The various steps involved in the Salpingo-oophorectomy procedure are:

1. Firstly, the doctor will administer the anaesthesia to keep you asleep during the surgery.
2. The doctor will clean the area below the abdomen using alcohol. 
3. Then, the doctor will make a 2 to 3 incision below the belly button on the cleaned area. 
4. A laparoscope (thin tube with the the the camera on end) is inserted into your abdomen through an incision.
5. The other surgical instruments are inserted through the other incisions.
6. Once done, the abdomen is inflated to create more space to allow the surgeon to work using carbon dioxide gas.
7. The surgeon carefully cuts and removes the ovaries and fallopian tubes from the body.
8. Finally, the surgeon seals the incisions with stitches or surgical tape.
9. The incisions are then covered with the help of a bandage.

It takes on average 1 to 2 hours to complete the surgery. You will stay at the hospital for a day or two. After surgery, you will be transferred to the recovery room. The medical staff will monitor your vitals (Blood pressure, pulse, oxygen or more). After you wake up, the medical staff or nurse will help you walk as it lowers the risk of blood clots. You will be discharged from the hospital when your condition stabilizes, and pain subsides. It may take four to six weeks to fully recover from the surgery. You may experience tiredness and low energy after the surgery for some weeks, which is normal. There might be some vaginal discharge after the surgery. The doctor will prescribe antibiotics and painkillers on discharge. You should avoid heavy lifting and exercise for some weeks post the surgery. 

FIrst up follow up with the doctor

You will have the first follow-up with the doctor after a week or seven days from the day of discharge. The medical staff will design a regular check-up schedule for you with the doctor. The doctor may perform some blood tests and imaging tests. It is to check for recovery and complications (if any). You will have a second follow-up with the doctor a month after. The recovery duration varies between individuals and the severity of the condition.

When Should you consult the Doctor

Salpingo-oophorectomy is a safe procedure with a high success rate. However, there are some risks and complications associated with the surgery. You must consult your doctor immediately if you face any risks or complications after the surgery, such as:

1. Bad  response to Anesthesia
2. Bleeding
3. Infection at the site of operation
4. Blood clots
5. Damage to nearby nerves
6. Hernia
7. Bowel obstruction
8. Increased abdominal pain and Chest pain
9. Swelling and redness at the incisions
10. Leakage or drainage from the wound
11. Foul-smelling discharge from the vagina
12. Excessive vaginal bleeding
13. Fever, nausea, or vomiting
14. Shortness of breath
15. Difficult in urinating
16. Urinary incontinence
17. Retention of ovary cells: Your ovary cells could keep causing problems, like pain near your pelvis.
18. Loss of fertility
19. Damage to bladder or bowel (rare)