Pelvic Congestion Syndrome Following Salpingectomy Compared to Tubal Ligation at Time of Caesarean Section: A Randomized Clinical Trial

Background & Objective: Permanent tubal sterilization during cesarean section is a reliable method of contraception. It is done either by bilateral tubal ligation or bilateral salpingectomy according to the surgeon’s preference. To evaluate the effects of tubal ligation versus bilateral salpingectomy during cesarean section in terms of pelvic venous congestion.Materials & Methods: A randomized clinical trial was conducted from January to August 2024 at Ain Shams University hospitals. Sixty-four pregnant women undergoing Cesarean section and requesting permanent contraception were randomized into two groups: tubal ligation (n=32) and bilateral salpingectomy (n=32). Postoperative evaluation after ten weeks included a structured symptom questionnaire and transvaginal duplex ultrasound assessment for signs of pelvic venous congestion.Results: Ultrasound findings showed dilated pelvic plexus veins in 13.3% of the tubal ligation group and 6.9% of the salpingectomy group (P=0.671). Crossing veins in the myometrium were present in 36.7% of tubal ligation patients versus 24.1% of salpingectomy patients. Duplex waveform changes during Valsalva’s maneuver were detected in 13.8% of the tubal ligation group and 7.1% of the salpingectomy group (P=0.670). The mean ovarian vein diameter measured 4.07±0.74 mm in the tubal ligation group compared to 3.83±0.85 mm in the salpingectomy group (P=0.253).Conclusion: There were no significant differences between those getting bilateral salpingectomy during a cesarean section and those undergoing tubal ligation in terms of intraoperative and postoperative outcomes, menstrual abnormalities, or pelvic venous congestion. Bilateral salpingectomy demonstrated similar safety to tubal ligation in terms of operative complications, menstrual cycle disturbances, and pelvic pain.