Salpingo Oophorectomy
Salpingo Oophorectomy
Salpingo Oophorectomy
Patient Evaluation
T is surgery is typically per ormed to remove
ovarian pathology that has been evaluated sonographically. I anatomy is unclear,
magnetic resonance (MR) imaging may add
in ormation. As listed in Chapters 35 and 36
(pp. 742 and 761), tumor markers are selectively drawn prior to surgery i malignancy
is suspected.
INTRAOPERATIVE
Surgical Steps
Anesthesia and Patient Positioning.
Salpingo-oophorectomy per ormed via laparotomy typically requires general anesthesia to allow staging o the upper abdomen i
malignancy is ound. T e patient is supine.
A ter anesthesia induction, hair in the
planned incision path is clipped i needed;
a Foley catheter is inserted; and abdominal
preparation is completed. Because o a possible need or hysterectomy i malignancy is
ound, the vagina is also surgically prepared.
Abdominal Entry. Either a transverse or
vertical incision may be used or SO. Clinical
actors such as ovarian size and risk o malignancy in uence this selection, as discussed on
page 926.
Following abdominal entry, cell washings
rom the pelvis and upper abdomen are collected prior to ovarian manipulation. T ese
are sent or pathologic evaluation i cancer
is ound. T e upper abdomen and pelvis are
explored. Peritoneal or omental implants are
sampled and sent or intraoperative rozensection analysis.
Consent
In general, serious complications with SO
are in requent but include organ injury,
especially to the ureter; hemorrhage; wound
in ection or dehiscence; and anesthesia complications. Ovarian pathology is the most
common indication or SO. T us, the possibility o cancer staging and a description
o its steps are explained. Moreover, malignant cyst rupture and spillage are risks, and
patients are in ormed that this will advance
the cancer stage (Chap. 35, p. 748). Many
women undergoing SO or ovarian pathology have associated pain. Although removal
o the ovary in most cases will be curative,
in other instances, pain may persist despite
SO. Last, i per ormed bilaterally, SO dramatically curtails estrogen production. T us,
a preoperative discussion o consequences, as
outlined on page 951, is recommended.
C
H
A
P
T
E
Bowel preparation and antibiotics are typically not required preoperatively. I hysterectomy is required during ovarian staging,
antibiotics may be given intraoperatively.
Laparotomy dictates venous thromboembolism prophylaxis, and options are ound in
able 39-8 (p. 836).
Salpingooophorectomy
Patient Preparation
43 6
935
936
POSTOPERATIVE
Patient recovery is similar to that described
or laparotomy (p. 928). In reproductive-aged
women, i only one ovary is removed, hormonal and reproductive unction is preserved.
However, i both are excised, then surgical
menopause ollows, and hormone replacement
is considered (Chap. 22, p. 494).