Main Article Content
Objectives: To characterize the clinicopathological features of adnexal masses arising subsequent to hysterectomy and portion of them requiring re-operation. In addition, average time interval between hysterectomy and diagnosis of adnexal mass was ascertained along with the need of salpingectomy
Materials and Methods: This observational study was conducted on the patients who presented with adnexal mass subsequent to hysterectomy. Data regarding characteristics of lesion, clinical presentation, proportion requiring re-operation and histological nature were analyzed.
Results: Over the span of 4 years, 115 women with hysterectomy presented with adnexal mass. 93% of them had index hysterectomy abdominally. Out of this 115 patients, 45 (39%) were kept on follow-up in whom mass had resolved subsequently (expectant group) and 70 (61%) required operation for the cure (re-operation group). Median time interval to diagnosis of adnexal mass was longer in re-operation group (p < 0.001). Patients in re-operation group were more symptomatic (p = 0.011), presented with larger size (p < 0.001) and more complex cyst (p = 0.0001) with higher number of septa (p = 0.007) compared to expectant group. In 74% of patients, mass arose from the ovary and accounted for 72.3% of the benign mass and 100% of malignant mass. In remaining 26%, tube was confirmed as the source of origin. Commonest histological variety was serous cystadenoma.
Conclusion: Significant number of adnexal lesion disappeared during follow up. Benign ovarian mass was the predominant lesion in re-operated group. Fallopian tube also contributed prominently in 26%, thus salpingectomy with hysterectomy shall decrease the occurrence of fallopian tube pathology.
2. Karp NE, Fenner DE, Burgunder- Zdravkovski L, Morgan DM. Removal of normal ovaries in women under age 51 at the time of hysterectomy. Am J Obstet Gynecol 2015;213:716.e1-6.
3. Davey AK, Maher PJ. Surgical adhesion: a timely update, a great challenge for the future. J Minim Invasive Gynecol 2007;14:15-22.
4. Yoon SH, Kim SN, Shim SH, Kang SB, Lee SJ. Bilateral salpingectomy can reduce the risk of ovarian cancer in the general population: a meta-analysis. Eur J Cancer 2016;55:38–46.
5. Holub Z, Jandourek M, Jabor A, Kliment L, Wagnerova M. Does hysterectomy wiyhout salpingo-oopherectomy influence the re-operation rate for adnexal pathology? A retrospective study. Clin Exp Obstet Gynecol 2000; 27:109-12
6. Lalooei A, Hashemi S R, Khosravi M H. Histopathological distribution of ovarian masses occurring after hysterectomy: a five-year assay in Iranian patients, Thrita 2016;5:e33131.
7. Loft A, Lidegaard O, Tabor A. Incidence of ovarian cancer after hysterectomy: a nationwide controlled follow up. BJOG 1997;104:1296-301.
8. Suh-Burgmann E, Hung YY, Kinney W. Outcomes from ultrasound follow-up of small complex adnexal masses in women over 50. Am J Obstet Gynecol 2014; 211:623.e1-7.
9. Casiano ER, Trabuco EC, Bharucha AE, Weaver AL, Schleck CD, Melton LJ 3rd, et al. Risk of oopherectomy after hysterectomy. Obstet Gynecol 2013;121:1069-74.
10. Shiber LD, Gregory EJ, Gaskins JT, Biscette SM. Adnexal masses requiring reoperation in women with previous hysterectomy with or without adnexectomy. Eur J Obstet Gynecol Reprod Biol 2016;200:123-7.
11. Diamond MP, Wexner SD, diZereg GS, Korell M, Zmora O, Goor HV, et al. Adhesion prevention and reduction: current status and future recommendations of a multinational interdisciplinary consensus conference. Surg Innov 2010;17:183-8.
12. Morse AN, Schroeder CB, Magrina JF, Webb MJ, Wollan PC, Yawn BP. The risk of hydrosalpinx formation and adnexectomy following tubal ligation and subsequent hysterectomy: a historical cohort study. Am J Obstet Gynecol 2006;194:1273-6.
13. Falconer H, Yin L, Grönberg H, Altman D. Ovarian cancer risk after salpingectomy: a nationwide population-based study. J Natl Cancer Inst 2015;27:107:dju410.
14. Chao X, Wang X, Xiao Y, Ji M, Wang S, Shi H, et al. Effects of hysterectomy with simultaneous bilateral salpingectomy on the subsequent pelvic mass. J Ovarian Res 2019;12:27:1-8.
15. Ayşegül Öksüzoğlu, Şebnem Özyer, Özlem Yörük, Rıfat Taner Aksoy, Ömer Hamit Yumuşak, and Özlem Evliyaoğlu. Adnexal lesions after hysterectomy: A retrospective observational study. J Turk Ger Gynecol Assoc 2019;20: 65-9