Prophylactic salpingectomy in women undergoing hysterectomy for benign gynaecological disease - a new Danish recommendation

TY - CONF

T1 - Prophylactic salpingectomy in women undergoing hysterectomy for benign gynaecological disease - a new Danish recommendation

AU - Sloth, Sigurd Beier

AU - Gimbel, Helga

AU - Jørgensen, Annemette

AU - Schroll, Jeppe Bennekou

AU - Møller, Charlotte

N1 - Conference code: 24

PY - 2015/10/7

Y1 - 2015/10/7

N2 - Background In May 2015 we published a national clinical guideline on hysterectomy for benign gynaecological conditions in cooperation with the Danish Health and Medicines Authority. One of nine investigated areas of interest was whether or not to remove the fallopian tubes in women undergoing hysterectomy for benign gynaecological disease. Methods A guideline panel of gynaecologists predefined critical and important outcomes for the assessment. The critical outcomes were defined as reoperation, operations on salpinx, fallopian tube cancer, ovarian cancer and post-operative levels of Anti-Müllerian Hormone (AMH). The important outcomes were defined as post-operative infections. A search specialist conducted a systematic literature search for publications from 2004 to 2014 in English, Danish, Norwegian and Swedish. In our first search we looked for existing guidelines in the Guidelines International Network, the National Institute for Health and Care Excellence, the National Guideline Clearinghouse, the Scottish Intercollegiate Guidelines Network, the Health Technology Assessment Database, the Cochrane Library, MEDLINE, EMBASE, CINAHL and Danish, Swedish and Norwegian national directorates of health and societies for gynaecology and obstetrics. In our second and third search we looked for systematic reviews and primary literature in MEDLINE and EMBASE. Two independent experts screened the search results. The guideline panel reviewed the literature. The quality of evidence was rated according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results The systematic literature search produced 269 hits for existing guidelines, 407 hits for systematic literature and 476 hits for primary literature. One randomized controlled trial (RCT, n = 30) and three observational studies (OS, n = 540, 282, 158) met the inclusion criteria. The quality of evidence for all critical and important outcomes was rated very low. For the critical outcomes evidence from one OS showed fewer reoperations (RR 0.33 95% CI 0.1 to 1.06) and operations on salpinx (RR 0.15 95% CI 0.01 to 2.46) after hysterectomy with concomitant bilateral salpingectomy compared to hysterectomy without salpingectomy. Evidence from one RCT and one OS showed no differences in the post-operative levels of AMH when comparing the two surgical procedures. There were no reports of fallopian tube cancer and ovarian cancer in the included studies. For the important outcomes evidence from one OS showed fewer postoperative infections (RR 0.23 95% CI 0.07 to 0.77) after hysterectomy with concomitant bilateral salpingectomy. Conclusions The overall quality of evidence was very low. The evidence showed better outcomes for women undergoing hysterectomy with concomitant bilateral salpingectomy compared to women undergoing hysterectomy without bilateral salpingectomy. Based on the available evidence, the balance between benefits and harms and patient values and preferences, the guideline panel gave a weak recommendation for concomitant bilateral salpingectomy in women undergoing hysterectomy for benign gynaecological disease.

AB - Background In May 2015 we published a national clinical guideline on hysterectomy for benign gynaecological conditions in cooperation with the Danish Health and Medicines Authority. One of nine investigated areas of interest was whether or not to remove the fallopian tubes in women undergoing hysterectomy for benign gynaecological disease. Methods A guideline panel of gynaecologists predefined critical and important outcomes for the assessment. The critical outcomes were defined as reoperation, operations on salpinx, fallopian tube cancer, ovarian cancer and post-operative levels of Anti-Müllerian Hormone (AMH). The important outcomes were defined as post-operative infections. A search specialist conducted a systematic literature search for publications from 2004 to 2014 in English, Danish, Norwegian and Swedish. In our first search we looked for existing guidelines in the Guidelines International Network, the National Institute for Health and Care Excellence, the National Guideline Clearinghouse, the Scottish Intercollegiate Guidelines Network, the Health Technology Assessment Database, the Cochrane Library, MEDLINE, EMBASE, CINAHL and Danish, Swedish and Norwegian national directorates of health and societies for gynaecology and obstetrics. In our second and third search we looked for systematic reviews and primary literature in MEDLINE and EMBASE. Two independent experts screened the search results. The guideline panel reviewed the literature. The quality of evidence was rated according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results The systematic literature search produced 269 hits for existing guidelines, 407 hits for systematic literature and 476 hits for primary literature. One randomized controlled trial (RCT, n = 30) and three observational studies (OS, n = 540, 282, 158) met the inclusion criteria. The quality of evidence for all critical and important outcomes was rated very low. For the critical outcomes evidence from one OS showed fewer reoperations (RR 0.33 95% CI 0.1 to 1.06) and operations on salpinx (RR 0.15 95% CI 0.01 to 2.46) after hysterectomy with concomitant bilateral salpingectomy compared to hysterectomy without salpingectomy. Evidence from one RCT and one OS showed no differences in the post-operative levels of AMH when comparing the two surgical procedures. There were no reports of fallopian tube cancer and ovarian cancer in the included studies. For the important outcomes evidence from one OS showed fewer postoperative infections (RR 0.23 95% CI 0.07 to 0.77) after hysterectomy with concomitant bilateral salpingectomy. Conclusions The overall quality of evidence was very low. The evidence showed better outcomes for women undergoing hysterectomy with concomitant bilateral salpingectomy compared to women undergoing hysterectomy without bilateral salpingectomy. Based on the available evidence, the balance between benefits and harms and patient values and preferences, the guideline panel gave a weak recommendation for concomitant bilateral salpingectomy in women undergoing hysterectomy for benign gynaecological disease.

U2 - 10.1007/s10397-015-0918-0

DO - 10.1007/s10397-015-0918-0

M3 - Poster

T2 - ESGE European society Gynecologic Endoscopy

Y2 - 6 October 2015 through 10 October 2015

ER -