ACOG has issued a Clinical Practice Update replacing its 2019 Committee Opinion on opportunistic salpingectomy. It further supports complete, bilateral salpingectomy at the time of obstetric and gynaecological surgery for primary prevention of epithelial ovarian cancer. It also expands the recommendation to offering salpingectomy during non-gynaecological abdominopelvic surgery.
The shift reflects the view that many high-grade serous cancers begin in the fallopian tube. Removing the tubes when the abdomen is already open adds little operative time and does not appear to bring forward menopause.
In practice, this touches hysterectomy for benign disease, caesarean sterilisation in place of tubal ligation, and — through referral pathways — general and colorectal surgery. It is a counselling conversation that should happen before consent, not in theatre.
- Offer complete bilateral salpingectomy at hysterectomy with ovarian conservation.
- At caesarean sterilisation, discuss salpingectomy rather than partial tubal ligation.
- Document the counselling and the patient's decision at consent.
- Talk to general surgical colleagues about offering it during other abdominopelvic operations.
- Salpingectomy does not replace risk-reducing salpingo-oophorectomy for BRCA carriers.
Why it matters
Ovarian cancer prevention becomes part of routine consent for hysterectomy, sterilisation and some non-gynaecological surgery.
Don't overread it
This is a guidance update; the cancer-prevention benefit rests on observational data, not a randomised trial.
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