ACOG published a Clinical Practice Update in August that replaces its 2019 Committee Opinion on opportunistic salpingectomy. It further supports complete bilateral salpingectomy at the time of obstetric and gynaecological surgery for the primary prevention of epithelial ovarian cancer, and it argues for making salpingectomy available during non-gynaecological abdominopelvic surgery as well.
The rationale is that many epithelial ovarian cancers, particularly high-grade serous cancers, are thought to arise in the fallopian tube. Removing the tubes when the abdomen is already open adds a small amount of operating time, and for women who have completed their families it replaces tubal ligation as the sterilisation method to discuss.
The practical change sits in counselling and consent: raise salpingectomy before hysterectomy, caesarean sterilisation and other pelvic procedures, and talk with surgical colleagues about offering it during their operations. The update is guidance, not a new trial; the expected cancer reduction rests on observational and modelling evidence, and the extension to non-gynaecological surgery depends on local pathways and consent.
- Offer complete bilateral salpingectomy rather than tubal ligation when discussing sterilisation at caesarean or laparoscopy.
- Raise salpingectomy in consent for benign hysterectomy where ovaries are being conserved.
- Talk with general surgical and urology colleagues about offering it during their abdominopelvic operations.
- Record in the consent that the aim is ovarian cancer risk reduction and that the effect is not guaranteed.
- Check that women who still want future pregnancy are excluded from the offer.
Why it matters
It turns sterilisation and routine pelvic surgery into an opportunity for cancer prevention, and widens who should offer it.
Don't overread it
This is a practice update from one society; the cancer reduction is inferred from observational and modelling data, not a randomised trial.
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