Is a bilateral salpingectomy putting myself at unnecessary risk?
July 18, 2019 4:53 PM   Subscribe

I am scheduled for a bilateral salpingectomy in a few months. I have wanted a tubal ligation ever since I was a teen and learned about the procedure. I have never wanted kids. I should be thrilled to have a doctor willing to do the procedure and insurance that covers it, but I'm suddenly filled with fear over the procedure - specifically general anesthesia and intubation. I'm worried I'm putting my body at unnecessary risk especially given that I probably only have 10-15 more years of fertility to deal with. Help talk me back into this?

More details. I am 39 and have never wanted kids. The issue was finding a doctor who would do this procedure, and insurance to cover it, so I stayed on the pill for over 20 years. I went off the pill earlier this year and it turns out my body is WAY happier off the hormonal birth control. Condoms suck, so I recently felt extra motivated to find a way to make my dream of being permanently child-free possible.

I now have a GYN who is happy to do the procedure and my insurance is fantastic. My doctor only performs it as a bilateral salpingectomy which is great since it reduces cancer risk and has no chance of regrowth. yay. But here is where my issue comes in.

My doctor explained the procedure - in a hospital but outpatient, general anesthesia, my abdomen will be blown up with gas, and I will be intubated. Suddenly at the realization of being intubated and under general anesthesia I have become terrified of the procedure. I don't know why! I guess it now is a reality that this is a fairly major procedure. I could die. I hate that I'm now second guessing myself and I could use some reassurance that I'm not putting myself at unnecessary risk.

Is there anything I should be thinking about in terms of reducing the risk? I'm overweight so I am going to make a serious effort to lose weight before the surgery (my doctor did not bring this up but I know being overweight increases risk in surgery). I don't smoke tobacco but I do enjoy weed (vaped) and cutting this out before surgery would not be an issue. Am I just overthinking this completely?
posted by joan_holloway to Health & Fitness (30 answers total) 5 users marked this as a favorite
Have you looked into IUDs as an alternative? They last 5ish years and are definitely less invasive. The way the Mirena IUD was explained to me is that the hormones work only locally within your uterus unlike with the pill. I got one mostly to make my periods essentially go away until I hit menopause (in theory, it's too soon to tell for sure how my body will react). (sorry if this is somewhat off-topic, since it isn't specifically how to make the surgery less risky)
posted by kbuxton at 5:18 PM on July 18, 2019 [1 favorite]

I am not a doctor. This is not a substitute for talking to a doctor. I have had two endometriosis surgeries under general anesthesia and one adult tonsillectomy. They have all given me such relief and peace of mind that I would do any or all of them again. I had a lot of feelings before and after each surgery.

This surgery is less likely to kill you than a pregnancy is. You want this surgery because it will help you prevent pregnancy.

Pregnancy could kill you. You don't want a pregnancy. Abortion is less likely to kill you than pregnancy, but abortion also comes with risks.

Return to your priorities about not becoming pregnant. 15 years of worrying about becoming pregnant is a long time.

To reduce your risk from surgery: follow the instructions about eating and drinking before surgery. They are imposed to prevent you from vomiting during the surgery. Vomiting during surgery is one of the biggest risks, because people under anesthesia are more likely to inhale the vomit.

Do not focus on weight loss. Focus on building your cardiovascular strength. This can be accomplished with whatever exercise is fun for you to do that you will engage in regularly. You want strong lungs and a healthy heart so that your circulation will remain good during and after surgery. Walking is a good exercise for this. A trip or three around your block every day, more if you feel like it but get at least once around. Walk briskly and try to get sweaty. Take the stairs instead of the elevator for 1-3 floors if you want. You don't need a difficult or stressful routine to get ready for surgery.

My post surgery suggestion is that the shoulder pain from the gas is...real. Have a heating pad around for it, take the medication they prescribe for pain on schedule. Get specific written instructions for how much physical activity to do after surgery. My second endo surgeon told me to take a walk the day after surgery. I strolled around for Three Miles and that was...according to my doctor, too much. But I felt So Good after the surgery than before that a three mile walk was amazing and restorative.
posted by bilabial at 5:28 PM on July 18, 2019 [17 favorites]

I have not had just that procedure (though I've had 3 surgeries: Gallbladder, Endo resection with Appendectomy, and a partial hysterectomy - leaving one ovary and part of my cervix.) I'm also chronically ill.

However from what I've heard, this procedure is EXTREMELY low key. Most (all?) laparoscopic surgery will put you under general anesthesia, have port incisions, and fill your belly with gas. It kinda sucks. It will hurt a bit. You'll feel pretty bloated. Your throat may be a bit sore. But this is also a very minimally invasive procedure.

These things can be anxiety inducing. But they also happen all the time, without any issues. Please speak to your doctor about your fears and the issues that may arise. Make sure you trust your doctor. But anxiety about this is normal. I would also consider treating your body kindly rather than trying to force any weight loss. Stability is best for surgery.

Sure, there ARE risks. And it's a good idea to understand them. But you also take a risk bigger getting into a car. And an accidental pregnancy has its own set of risks.

I had my partial hysto mostly for pain management - but I also never wanted kids. And even though any surgery is more complex for me due to illnesses, I've come out from them fine, eventually. And I'm so fucking glad I can never get pregnant - even though my spouse had a vasectomy - it still feels very freeing.
posted by Crystalinne at 5:30 PM on July 18, 2019 [5 favorites]

I've had the Mirena IUD (hormonal--not a lot, but more than my body liked), and then the Paragard (nonhormonal, worked very well for me). The Paragard is licensed for 10 years or and can stay in up to 15 if you are close to menopause. It took me all the way through menopause, and I was super happy with it. I also considered tubal ligation, but decided to try the Paragard first and was very happy that I did.
posted by Emera Gratia at 5:31 PM on July 18, 2019 [4 favorites]

I've seen statistics that you're more likely to die in a car crash on the way to the hospital than for the anesthesia to kill you. I can't find hard numbers to back that up right now, but this Yale doctor says basically the same thing.
posted by teremala at 5:51 PM on July 18, 2019

I'm not a doctor, or any sort of expert, but recently I have had a lot of exposure to the surgical and perianesthesia environments at a local hospital. If you have any questions, reservations, or requests about your anesthesia care plan, it is very important to speak directly to the anesthesiologist or anesthetist handling your case rather than the surgeon. During a typical surgery in a hospital, there are two attending physicians with well-defined responsibilities-- the anesthesiologist, and the surgeon, and while they communicate to provide care for you, they definitely have clearly defined scopes and responsibilities.

It is possible to have laparoscopic, or even open abdominal surgery without general anesthesia and intubation. The situation I have most commonly seen is the use of a spinal and/or epidural, plus an intravenous anesthetic. The patient in these cases is usually sedated to the point where they will not remember anything, but can still breathe on their own, and usually respond minimally to simple verbal commands or requests.

Of course, all this depends on whether you have any reasons why this would be a bad choice in your particular case, and also, the plan can change while things are underway according to the best judgment of the physician.

That said, as previously mentioned, any and all of these choices are very safe, and your operation is relatively minor for cases that involve general anesthesia.
posted by Maxwell_Smart at 6:15 PM on July 18, 2019 [1 favorite]

Hi! I will have to get one of these procedures (plus an oophorectomy), on account of my fucked-up genes! I have already had a mastectomy and reconstruction, on account of my fucked-up genes. Like you, I was TERRIFIED!!! of general anesthesia. However, my boyfriend is an actuary and was able to comfort me with raw, unadulterated numbers. I'm NOT an actuary, but I'll try to sum it up: you will be safer under anesthesia than you'd be, like... sitting in your living room, where you could presumably have a heart attack or choke on a Frito. It is incredibly, incredibly safe. You will be monitored constantly by several people with incredibly advanced training. This does not remove the visceral fear, I know - and it's a horrible, gnawing fear - but just tell yourself "I can feel the fear AND know the fear is not based in fact, and not act on the fear!" And then do it. It'll be easier than you know. Hang in there.
posted by julthumbscrew at 6:51 PM on July 18, 2019 [4 favorites]

When I had my hysterectomy, I was very anxious. I talked to the anesthesiast and they gave me a light sedative while I was waiting for the surgical prep, that combined with a warming suit was incredibly comforting and relaxing, so yes, discuss this with both surgeon and anesthesiast, and they will help work out a course of action that will give you a satisfactory experience.
posted by LaBellaStella at 7:02 PM on July 18, 2019 [4 favorites]

You will drastically reduce your risk of ovarian cancer if you have this procedure done. Some other interesting facts in the linked article.
posted by acridrabbit at 7:25 PM on July 18, 2019 [3 favorites]

I had my tubes tied many years ago. The formal name of the procedure used has escaped me if I ever even knew it, but the methodology you described sounds like what I went through. It wasn't my very first surgery under general anesthesia, and lord knows it wasn't the last, but it was really no big whoop. I remember being distended around the belly for about a week from the gas and my throat was a bit sore for a day or so. I had been warned that my shoulders might be sore, also from the gas, but I never experienced that.

Like you, I never wanted kids. At the time, and even now, having the tubal ligation was for me a statement that I was taking charge of my life and reproductive future. It felt liberating and I have never regretted it. Not even when, about a year later, I ended up having a hysterectomy because of a fibroid tumor that grew like the Mean Green Mother From Outer Space.

This is all just one woman's experience. But this woman has been where you are, and I'm telling you the surgery is not a big deal and as long as you're sure this is right for you - and it sounds like you are - there is nothing to be worried about. Yes, definitely lose some weight. Also anything you can do to tone up your abdominal muscles will be helpful, I would think. Oh, and make sure you have some elastic waistband pants and the like because your belly will be distended and a bit tender.
posted by DrGail at 7:28 PM on July 18, 2019 [3 favorites]

I had my tubes tied after the c-section birth of my second. I chose that route over other forms of birth control because I was DONE and I wanted a non-invasive (as in sticking things in there for a long period of time) method. I had zero problems with the procedure.

I've also had outpatient laparascopic abdominal rooting around - complete with the gas in the belly - and all I experienced was some uncomfortable bloating and that was it.
posted by tafetta, darling! at 7:29 PM on July 18, 2019 [1 favorite]

I have not had this surgery, but I have been the day-of caretaker for someone having this procedure. I have also had two c-sections, wisdom tooth removal under full anesthesia, and have been the parent of an infant undergoing anesthesia for an MRI and two surgeries. I get your concern, but I do think you're overthinking it.

There is always risk with anesthesia. And most of the time, the benefits outweigh the risk.

When I assisted with the recovery of the person who had this surgery, it was a fairly quick procedure. They woke up groggy and uncomfortable but not in dire pain. They slept a lot that afternoon. We were up and about, going a little more slowly than usual, the next day. I don't recall them complaining about the shoulder pain at all (the shoulder pain was the worst part of my first c-section, by far). The biggest downside of the situation was primarily that we could not watch the recovery show I'd picked out (The Good Place), because they were too sore to laugh.

They have never expressed regret to me about the surgery, but have expressed delight and relief several times. You sound like a case study for the benefits of this procedure.
posted by peanut_mcgillicuty at 7:31 PM on July 18, 2019

I don't have a solution in mind, but I felt the same way when I was getting my tonsillectomy earlier this year. It was very medically optional - I didn't like that I got bad breath on occasion from small tonsil stones, and I also hoped it would help with my snoring, even though the ENT didn't think it would. And of course they put me under general anesthesia.

So I know the feeling of knowing that I am adding risk unnecessarily. However, I guess I just got back from a trip where I rented a car and it wasn't totally necessary.

The rowing machine / versa climber are surprisingly fun for fitness / cardio, btw.
posted by batter_my_heart at 8:03 PM on July 18, 2019

Wow, this is great feedback to receive so quickly! Thank you to everyone. I think it is the need for intubation that scares me the most - the idea of my lungs being temporarily immobilized from the anesthesia isn't something I thought about before and that sounds crazy to me. It is helpful to hear that the risk is lower than many other things I already do day to day without thought.

I think I need to remind myself of my biggest motivation - as DrGail said so well above, this is about me taking charge. The freedom that would come with not having to worry about an unwanted pregnancy will be a huge quality of life improvement that I will probably wish I could have enjoyed sooner once this is all done. I did consider an IUD but I don't like the possibility of having to replace it in x number of years. Also, I have fibroids and painful/heavy periods already which I know an IUD could make worse. In all, it has always seemed like the tubal procedure made a lot more sense.

I am surprised to hear I don't necessarily need to lose weight, but I probably should anyway, so I might pretend I never saw that to motivate myself. I already do powerlifting and have a decent core, so hopefully that will help me. Adding in cardio would be a good idea given my family history with heart issues in general.

Thanks again. I am already feeling a lot less freaked out.
posted by joan_holloway at 8:06 PM on July 18, 2019 [8 favorites]

Fellow salpingectom-er here, had the surgery at about your age (because it also took forever to find a doctor 😡). I tried Mirena first and haaaaaated it. Minority there, it seems.
Anyway, the surgery and recovery from it were fine. The air thing was the weirdest part, I did get shoulder pain. I was able to take it easy and not lift heavy things as per my Dr's instructions and I have been living in child and hormone free bliss ever since. It's one of the best things I've ever done for myself.
Not a Dr myself so I can't advise on risk per se, but it did not feel risky to me at the time, echoing all the stats listed above.
posted by PaulaSchultz at 8:08 PM on July 18, 2019 [3 favorites]

The good news is, for the vast majority of people, going under general anesthesia and waking up is literally nothing. Like, time does not exist - unlike some of my experiences with sedation. You close your eyes, then open them and it's done. I have a variety of memories before/after surgery depending on the cocktail of meds. But, literally nothingness for anything close to the surgery part. So while the idea is freaky, your personal experience of it is non existent and you're usually preoccupied with doctors coming in and out then the followup recovery to manage.
posted by Crystalinne at 9:17 PM on July 18, 2019 [2 favorites]

Surgical outcomes are measured! You can ask your surgical team for their morbidity and mortality statistics in their series of general anesthesia abdominal laproscopic procedures. You (hopefully) will find zero death or debility from hypoxia under anesthesia or infection, and a very low percentage of complications requiring open revision (i.e., they have to operate again, and this time not laparoscopic).
posted by MattD at 10:33 PM on July 18, 2019 [2 favorites]

I was also very anxious prior to my endo surgery and really recommend talking to the anaesthesiologist - I think I got given a gentle sedative but I honestly can’t remember. They definitely listened to me and were reassuring.

one thing I found really helpful after my laparoscopic endo surgery (pretty much same deal vis a vis intubation etc.) was a small cushion held between my knees when I slept on my side - it really helped keep the strain off the laparoscopy stitches and meant that after the first night (without the cushion, foolishly on my back), I could do things like get up in the night for the bathroom without being stuck on my back and having to phone my mother to come through from the spare room to help me.

I did get the referred pain from the gas but it does go away fairly swiftly. It is just really annoying for the first day or two.
posted by halcyonday at 2:11 AM on July 19, 2019 [2 favorites]

I’ve had general anaesthetic once, at a similar age to you, and I know what you mean about it suddenly feeling kind of serious. But in reality, I found the anaesthetic.... kind of nice. Total lack of awareness and then woke up feeling pleasantly sleepy and relaxed, and there was nothing to do but lie in my bed dozing. Just make sure you give yourself plenty of time to rest and recover. I had 3 days off and then went into a major work event lasting a week, and that was a mistake - I wasn’t ready, in retrospect, and I think that was as much from the anaesthetic as the relatively minor procedure. It can make you sensitive emotionally as well as physically, but it’s nothing that rest can’t cure.
posted by penguin pie at 2:28 AM on July 19, 2019 [1 favorite]

Have not had *that* surgery (but did have a vasectomy earlier this year). I'd love to meet the cool cat who goes into a thing knowing they'll be put under and never has any anxiety at all.

I've never met them.

"probably only have 10-15 more years of fertility to deal with"

That's... a lot of time to be comprising on fun times, especially (from what I've been told) can be some of the best fun times of your life.

Get a close friend / family member to join you. Get it done. Recover. Feel free.
posted by chrisinseoul at 3:09 AM on July 19, 2019 [1 favorite]

Have had the surgery after trying IUD, pill, implanon, diaphragm, etc. Oh god I am so glad I had it done. SO. GLAD. Soglad.

Give yourself time to recover, definitely, but don't let your (totally natural, understandable) feelings of anxiety about this being a Serious Medical Procedure (which it is, but that's ok!) keep you from doing this thing that you want to do. 10-15 years is way too long to muddle through with less than optimal (for you) forms of birth control.

(Seriously, SO. GLAD.)
posted by somanyamys at 5:52 AM on July 19, 2019 [2 favorites]

I was extremely anxious the first time I had GA and surgery. I now think it's quite awesome (it's fascinating how one moment you are counting then a total blank then click you switch on again).

They take loads of precautions against the risks, like I had a plastic blowy thing to get my lungs back up to speed and these nifty leg massages to prevent clots. And you're so well prepped, with the pre fasting, coming off cointradicted meds if required, smoking etc. It's very different to someone needing major surgery because they were in a car crash just after eating a huge meal out.

FWIW the air they pumped in didn't cause me any discomfort. They get you to walk a lot to move it out.

And the surgery sounds like it will give you what you've long awaited which awesome.
posted by kitten magic at 6:25 AM on July 19, 2019

Have had a LOT of surgeries - assuming this one will be laparoscopic the recovery will easy. The risk is minimal as others have stated. The difference in recovery between an open surgery and laparoscopy is huge. And not having to worry about birth control is awesome.
posted by leslies at 6:50 AM on July 19, 2019

I have had a unilateral salpingectomy (as well as a unilateral oophrectomy) under emergency conditions, and can attest that it was not a big deal and something I bounced back from quickly. Disclaimer: I was only 26 and that may have helped my recovery speed, but the emergency nature may have also lead to things being a little more roughly-done, as I think they had to go with a more traditional incision instead of laprascopy. It still was fairly smooth (and the fact that this was the result of a freak thing that happened on a second date gave it all an element of the comedic).
posted by EmpressCallipygos at 7:05 AM on July 19, 2019 [1 favorite]

It sounds like the MeFi Endo Squad has all arrived *waves*, but I'll be one more voice to tell you that even though it sounds scary, it'll be OK. I had my most recent surgery about a year ago and had uterus/tubes/cervix out. My recovery was rougher than yours will be, because I also had lesions removed from all over my body cavity (peritoneum, bladder, ureters, etc.). But it still wasn't too bad, and at 6 months after, I didn't even think about it anymore.

You say that ditching the hormones has helped immensely. I think you're making the best choice with the salpingectomy. You can't count on "only" having 10-15 years of fertility ahead, and regardless, that is a LONG-ASS time compared with a few months to recover from surgery.

I have a feeling you know all that and you're mostly just scared about the surgery aspect. It's right and normal to be scared when someone's going to cut into you and your life/breathing will be in another's hands. But the procedure is very, very safe, and done literally all the time (if not to you). Breathe deep and jump and you'll get through it and I think you will be very glad you did.
posted by fiercecupcake at 7:30 AM on July 19, 2019 [2 favorites]

I’ve had a unilateral salpingectomy (scheduled, not an emergency) at age 33. Although I was off work for a week and swollen a bit longer, I have since recommended the surgery to a friend with a similar diagnosis. The surgery is straightforward, as is recovery. All surgery does have risks, but this is not an unreasonable one. I support your moving forward with this.
posted by samthemander at 7:39 AM on July 19, 2019

I've had surgery under general anesthesia and was, like you, super anxious around that aspect of the surgery specifically. One thing that really helped was that I was able to meet the anesthesiologist before surgery started, which I found very comforting. So that might help you as well.
posted by Ragged Richard at 8:22 AM on July 19, 2019 [2 favorites]

::Waves:: I think you will be fine and are overthinking it. Just FYI, 59, Morbidly Obese, Smoker, and have had gall bladder, appendectomy, lumpectomy, and just this past year, emergency umbilical hernia surgery. The last is probably the closest to what you are anticipating -- poking around all those lower abdominal, ovarian areas that seem to cause so many problems.

DOOOO EET! Seriously, the risks under General Anesthesia are real, but rare; the follow up discomforts also real, but temporary. Intubation may leave you with a tiny sore throat and a weird feeling in your mouth, but otherwise you probably won't notice.

On the latest surgery, I went in under a lot of severe pain (rupture) and the last thing I remember after talking to the surgeon was, "we're going to take care of that pain for you." I thought they meant a nice morphine drip. When I woke up, the worst of it was the pressure bandage on my abdomen because it itched so much! (And I took longer to heal up than I had on the gall bladder, because 20 years older.)

Just saying, if you never been under GA, it can be scary but it's mostly not. There are risks, but they are (as noted by others) pretty minimal. Everyone reacts differently to anesthesia, but your medical team will have seen nearly everything from the "itchies" to the pains from the inflating gas, and know the best way to mitigate.

The one thing I would highly recommend, is that if you are good terms with your employer, use that to make sure you get the recovery time you need. *Everyone* reacts differently. Be prepared to ask for a week off or to work partial days if at all possible. Do not overdo at home. With my laproscopic gall bladder surgery, I was back to work in two days. For the Hernia, I needed about a week (More muscles involved.)

I think you'll do just fine and as someone who actually had to wait for menopause, go for it. The whole pre-menopause, menopause gig is a huge pain in the ass.

posted by allandsome at 2:23 PM on July 19, 2019 [3 favorites]

I had my tubes tied and root canal surgery in the same year.
Guess which one I would rather do every week for the rest of my life? Not that I'm trying to talk you out of seeing your dentist....
Talk to the anesthesiologist. Getting knocked out is a breeze. Sleep soundly, wake up refreshed, and follow the doctor's post-surgery orders. Take it easy and lean on your status as post-surgery to get as much rest as possible.
Congratulations on leaving the hormones behind! Fewer risks, less worry.
posted by TrishaU at 6:28 AM on July 20, 2019 [1 favorite]

Here's the Ask I posted before my bilateral salpingectomy. It's been 4 years and is still one of the best decisions I've made for myself.

I don't remember the intubation at all. I think I was told to expect a sore throat, but it didn't bother me at all.

I'm happy to discuss further in MeFiMail, if you'd like.
posted by MuChao at 8:25 AM on July 20, 2019 [1 favorite]

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