A bilateral salpingectomy (or “bi salp”) is a surgical procedure involving the complete removal of both fallopian tubes, the ducts that serve as the passage for an egg to travel from the ovary to the uterus. This procedure is a permanent form of sterilization, preventing natural conception by eliminating the pathway for the egg and sperm to meet. Patients seeking the operation are typically looking for highly effective, irreversible contraception. The increasing adoption of this procedure is also driven by its secondary benefit of significantly reducing the risk of a specific type of cancer.
Complete Removal and Medical Rationale
The fallopian tubes are slender, muscular structures attached to the upper part of the uterus, ending near the ovaries. During the bilateral salpingectomy, the surgeon meticulously detaches and removes the entirety of both tubes, from the uterine wall to the delicate, fringe-like fimbriated end near the ovary. This complete removal offers permanent and highly effective contraception.
Beyond sterilization, the medical community increasingly recognizes the procedure as a powerful strategy for cancer risk reduction. Current research suggests that the most common and aggressive form of the disease, high-grade serous carcinoma, often originates not in the ovary itself, but in the lining of the fallopian tube, particularly at the fimbriated end. Removing the fallopian tubes proactively eliminates the tissue thought to be the starting point for this lethal malignancy, offering a significant preventative measure.
How This Differs From Tubal Ligation
The mechanism of a bilateral salpingectomy is fundamentally different from that of a traditional tubal ligation, commonly known as “getting your tubes tied.” Tubal ligation is a procedure that blocks, clips, bands, or severs a portion of the tube, leaving the majority of the tissue intact. While this effectively prevents fertilization, the remaining tubal segment is still present.
A salpingectomy involves the full excision of the entire organ, which is why it has largely become the preferred method for sterilization. This complete removal offers a greater reduction in the risk of ovarian cancer, with studies suggesting a risk reduction between 42% and 78%. In comparison, tubal ligation reduces the risk by a smaller margin, typically between 13% and 41%. The enhanced cancer prevention benefit, coupled with an even lower failure rate for permanent sterilization, has made bilateral salpingectomy the new standard of care for many patients seeking permanent contraception.
The Surgical Procedure and Recovery
The bilateral salpingectomy is overwhelmingly performed using a laparoscopic approach, often called keyhole surgery, which minimizes incisions and recovery time. The procedure is done under general anesthesia. The surgeon makes several small incisions, typically one near the navel, through which a camera and specialized instruments are inserted. The operation itself is relatively short, often lasting an hour or less.
Recovery begins immediately, and most patients are able to return home the same day. The most common side effects in the initial days are abdominal discomfort at the incision sites and a generalized soreness. Patients also often experience shoulder pain, which is a temporary result of the carbon dioxide gas used to inflate the abdomen during the laparoscopic procedure.
Managing pain with prescribed or over-the-counter medication is important in the first week. Most people can return to light work or desk duties within about a week, but heavy lifting and strenuous exercise are typically restricted for four to six weeks. Full physical recovery usually takes about two to four weeks, but patients must follow their surgeon’s instructions regarding incision care and activity restrictions.
Long-Term Health and Hormonal Effects
A common concern among patients is whether the removal of the fallopian tubes will trigger early menopause or disrupt hormonal balance. The fallopian tubes are purely reproductive conduits and do not produce hormones. Therefore, a bilateral salpingectomy, which involves the retention of the ovaries, does not cause surgical menopause.
The ovaries remain in place following the procedure, continuing to produce estrogen and progesterone and maintaining the normal menstrual cycle. The procedure does not significantly impact ovarian function or the reserve of eggs. For most patients, periods continue as usual until natural menopause occurs, unaffected by the tube removal. The most significant long-term health outcome is the lasting benefit of a substantially reduced lifetime risk for ovarian cancer.