Abstract
Objective:To characterize adnexal lesions detected in patients who had undergone previous hysterectomy with one or both ovaries conserved, and to define the clinical, pathologic, and surgical characteristics of the adnexal lesions in these patients.Material and Methods:A retrospective observational study was conducted on patients who had undergone a previous abdominal hysterectomy with one or both adnexa preserved and who had subsequently presented with an adnexal lesion. Characteristics of lesions, operative, and pathologic findings in patients who required a re-operation were noted.Results:One hundred thirty-seven patients presented with an adnexal lesion after hysterectomy. Of the 137 patients, 71 (51.8%) had undergone a re-operation (re-operated group), the rest of the patients (n=66, 48.1%) remained on follow-up (follow-up group) in whom the lesion disappeared during follow-up period. Adnexal lesions that were re-operated were significantly larger (p<0.001), more complicated (p=0.04), and had more septations (p=0.01) than in the follow-up group. The origin of the adnexal lesion was confirmed as the ovary in 59 (83%) patients, and as the peritoneum in 8 (11.2%) patients during surgery. All of the adnexal lesions arising after hysterectomy and required a re-operation were confirmed to be benign.Conclusion:Almost half of the lesions detected after hysterectomy disappeared during the follow-up period. The adnexal lesions that were re-operated were more symptomatic, larger, and had more complicated lesions. All lesions that were re-operated were found to be benign, mostly originating from the ovary.
Highlights
Hysterectomy is one of the most commonly performed surgical procedures among women [1], and the majority of these are performed for benign diseases of the uterus [2]
Patients who were eligible for the study were those with a previous abdominal hysterectomy for benign indications with one or both adnexa preserved during the years of 2007-2013, and had subsequently presented with an adnexal pathology
The mean age of patients at the time of hysterectomy who were later diagnosed as having adnexal lesion was 46.4±4.0 years (Table 1)
Summary
Hysterectomy is one of the most commonly performed surgical procedures among women [1], and the majority of these are performed for benign diseases of the uterus [2]. The major benefits of prophylactic salpingo-oophorectomy are the prevention of subsequent ovarian and breast cancer, and the reduction in the risk of future adnexal surgery [3]. Oophorectomy is associated with a number of potential risks in the long term related with earlier surgical menopause in premenopausal women who face risks of cardiovascular disease, osteoporosis and hip fractures, neurologic and psychiatric disorders, and colorectal and lung cancers [3]. The benefits must be weighed against these potential adverse effects during preoperative patient counseling and decision making. Recent studies investigating the trends of adnexal surgeries at the time of hysterectomy for benign indications suggested that the rate of ovarian preservation in women younger than 50 years of age was increasing [2,4]
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