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Impact of prior hysterectomy on surgical outcomes for laparoscopic adnexal surgery

  • Roa A. Alammari
  • Elisa M. Jorgensen
  • Anna M. Modest
  • Jennifer Chu
  • Louise P. King
  • Christopher S. AwtreyEmail author
Article
  • 35 Downloads

Abstract

Background

Adnexal surgery is believed to be more complex in patients with prior hysterectomy; however, there is little data regarding surgical outcomes. Understanding of individualized risks improves counseling, informed consent, and preoperative planning.

Methods

We performed a retrospective cohort study with a control group; we evaluated 744 patients undergoing laparoscopic adnexal surgery at an academic tertiary care center from 2011 to 2015. Comparisons were made using Chi square, Fisher’s exact, or Wilcoxon-rank sum tests. We used log-binomial regression to calculate risk ratio and 95% confidence interval.

Results

Patients with prior hysterectomy were more likely to have intraoperative or postoperative complications at the time of laparoscopic adnexal surgery when compared to patients without prior hysterectomy [17.7% vs. 10.2%, p = 0.02, risk ratio (RR) 1.7, 95% confidence interval (CI) 1.1–2.7]. Patients with prior hysterectomy were four times more likely to have intraoperative complications (3.2% vs. 0.8%, p = 0.047, RR 4.0, 95% CI 1.1–14.7), and five times more likely to have conversion to laparotomy (5.6% vs. 1.1%, p = 0.004, RR 5.0, 95% CI 1.8–14.0). Patients with prior hysterectomy were more likely to need additional procedures, including lysis of adhesions (69.4% vs. 26.0%, p < 0.001), ureterolysis (15.3% vs. 4.8%, p < 0.001), and cystoscopy (28.2% vs. 8.1%, p < 0.001). They had longer operative time [101.5 min (IQR 59.5–135.0) vs. 78.0 min (IQR 53.0–109.0, p < 0.001)], and were less likely to have outpatient surgery (56.5% vs. 84.8%, p < 0.01). Postoperative complications were also more common (15.3% vs. 9.4%, p = 0.046).

Conclusions

Patients with prior hysterectomy were 70% more likely to have a complication at the time of laparoscopic adnexal surgery than patients without hysterectomy. Increased risk of complications in subsequent adnexal surgery may influence the informed consent process or decisions regarding ovarian conservation. Awareness of potential need for additional surgical procedures may guide availability of equipment, choice of operating site, or referral to an advanced pelvic surgeon.

Keywords

Adnexal surgery Gynecologic surgery Hysterectomy Oophorectomy Ovarian cyst Perioperative complications 

Notes

Compliance with ethical standards

Disclosures

Roa A. Alammari, Elisa M. Jorgensen, Anna M. Modest, Jennifer Chu, Louise P. King, Christopher S. Awtrey have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Roa A. Alammari
    • 1
  • Elisa M. Jorgensen
    • 1
  • Anna M. Modest
    • 1
  • Jennifer Chu
    • 1
  • Louise P. King
    • 1
  • Christopher S. Awtrey
    • 1
    Email author
  1. 1.Department of Obstetrics & GynecologyBeth Israel Deaconess Medical Center & Harvard Medical SchoolBostonUSA

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