Bilateral Salpingo-Oophorectomy (BSO) is a surgical procedure in which both ovaries and fallopian tubes are removed. It is commonly performed for a variety of gynecological conditions ranging from benign diseases such as ovarian cysts and endometriosis to malignant disorders like ovarian or fallopian tube cancer. In some cases, it is carried out prophylactically in women who have a high genetic risk of ovarian or breast cancer. The procedure may be performed through traditional open surgery (laparotomy) or, more commonly today, through minimally invasive laparoscopic or robotic-assisted techniques.

Anatomy Involved

The ovaries are paired reproductive organs responsible for producing eggs (ova) and releasing female hormones, primarily estrogen and progesterone. The fallopian tubes connect the ovaries to the uterus and serve as the site of fertilization. Removal of these structures eliminates fertility and has significant hormonal implications, especially if the surgery is done before menopause.

Indications for Bilateral Salpingo-Oophorectomy

There are several medical reasons why surgeons recommend BSO:

Ovarian Cancer: BSO is often part of the surgical treatment of ovarian malignancies.

Fallopian Tube Cancer: Removal of the tubes is necessary when cancer originates there.

Endometriosis: Severe, refractory cases that involve both ovaries may warrant removal.

Large or Recurrent Ovarian Cysts: When cysts are symptomatic, recurrent, or suspicious for malignancy.

Pelvic Inflammatory Disease (PID): In cases of chronic infection leading to damage of ovaries and tubes.

Risk Reduction Surgery: Women with BRCA1, BRCA2, or Lynch syndrome mutations often undergo prophylactic BSO to reduce their risk of ovarian and breast cancers.

Adjunct to Hysterectomy: In women with uterine disease such as cancer, the ovaries and tubes may be removed simultaneously.

Surgical Techniques
Open Surgery (Laparotomy)

Traditionally, BSO was performed through a large abdominal incision. While this provides good access, it is associated with longer recovery times, more postoperative pain, and larger scars.

Laparoscopic Surgery

Currently, laparoscopic BSO is the preferred method. Small incisions are made in the abdomen, and a laparoscope (camera) along with specialized instruments are used to visualize and remove the ovaries and tubes. This technique offers:

Less postoperative pain

Minimal scarring

Faster recovery

Shorter hospital stay

Robotic-Assisted Surgery

In certain centers, robotic systems are employed for enhanced precision and dexterity. This is especially useful in patients with pelvic adhesions or complex anatomy.

Steps of Laparoscopic BSO

Anesthesia and Positioning – The patient is placed under general anesthesia in lithotomy position.

Port Placement – Small incisions are made, typically one at the umbilicus and two or three in the lower abdomen, for laparoscopic instruments.

Visualization – The abdominal cavity is inspected to rule out disease spread.

Dissection – The infundibulopelvic ligament (containing the ovarian vessels) is carefully sealed and divided. The utero-ovarian ligament and fallopian tube attachments are also divided.

Specimen Removal – The ovaries and fallopian tubes are removed through a retrieval bag, usually via the umbilical port.

Hemostasis and Closure – Bleeding is controlled, instruments are withdrawn, and small incisions are sutured.

Postoperative Care

Patients undergoing laparoscopic BSO usually recover quickly, often being discharged within 24 hours. They are encouraged to ambulate early, resume light activities within a few days, and avoid heavy lifting for 4–6 weeks. Pain is generally mild and managed with oral analgesics.

Follow-up includes monitoring for complications such as infection, bleeding, or injury to surrounding structures. If the procedure was done for cancer, additional treatment such as chemotherapy may be required.

Effects of Surgery

Loss of Fertility: Removal of both ovaries means the woman can no longer conceive naturally.

Hormonal Changes: If performed before menopause, the sudden drop in estrogen and progesterone can lead to surgical menopause, characterized by hot flashes, night sweats, vaginal dryness, mood changes, and increased risk of osteoporosis and cardiovascular disease.

Psychological Impact: Some women may experience emotional distress due to loss of fertility or hormonal changes. Counseling and support are important.

Advantages of BSO

Definitive treatment for ovarian or fallopian tube cancer

Prevents recurrence of ovarian cysts and endometriosis in both ovaries

Significantly reduces risk of ovarian and breast cancer in high-risk women

Can be performed safely with minimally invasive techniques

Risks and Complications

As with any surgery, BSO carries potential risks:

Bleeding

Infection

Injury to bladder, bowel, or ureters

Blood clots (DVT or pulmonary embolism)

Adhesion formation

Long-term consequences of early menopause

Conclusion

Bilateral Salpingo-Oophorectomy is a well-established surgical procedure with life-saving potential in cases of malignancy and risk-reduction. It also offers definitive management for certain benign gynecological conditions. With the advent of laparoscopy and robotic surgery, the procedure has become safer, less invasive, and associated with quicker recovery. However, the decision to undergo BSO should be individualized, considering the patient’s age, reproductive wishes, genetic risk, and overall health. Proper counseling, preoperative evaluation, and postoperative support ensure the best possible outcomes for women undergoing this significant procedure.