Risk Factors Associated with Adnexal Torsion after Hysterectomy.

Abstract

STUDY OBJECTIVE:

To identify preoperative and intraoperative risk factors for adnexal torsion after hysterectomy, and to estimate the incidence of the disease in the modern-day era of laparoscopic surgery.

DESIGN:

Retrospective nested case-control study.

SETTING:

Large urban medical system.

PATIENTS:

Eighty-nine female patients ages 17 to 51.

INTERVENTIONS:

Patients underwent ovarian-sparing hysterectomy.

MEASUREMENTS AND MAIN RESULTS:

The estimated incidence of ovarian torsion after hysterectomy was 0.5% (46/8538 ovarian-sparing hysterectomies). The following variables were found to be associated with adnexal torsion after hysterectomy in an adjusted logistic regression: laparoscopic or laparoscopic-assisted approach to hysterectomy vs any other approach (odds ratio [OR], 3.36; 95% confidence interval [CI], 0.86-13.23); younger age at the time of hysterectomy (17-40 years) vs older age (41-51 years) (OR, 3.45; 95% CI, 1.33-8.97); and a gynecologic history significant for endometriosis (OR, 4.07; 95% CI, 1.04-15.88).

CONCLUSION:

There is an association between laparoscopic approach to hysterectomy, younger age at time of hysterectomy, and a history of endometriosis with subsequent risk of adnexal torsion. Providers should have a heightened index of suspicion for adnexal torsion after hysterectomy in patients presenting with acute-onset abdominal pain who underwent laparoscopic hysterectomy at a younger age.

• Authors: Laura N Homewood, Eesha D Dave, Riyas Ali, Indika V Mallawaarachchi, Sarah J Ratcliffe, Goundappa K Balasubramani, Ted T M Lee
• Journal: Journal of minimally invasive gynecology (J Minim Invasive Gynecol) Vol. 29 Issue 2 Pg. 250-256 (02 2022) ISSN: 1553-4669 [Electronic] United States
• PMID: 34400354 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)
• Copyright: Copyright © 2021 AAGL. Published by Elsevier Inc. All rights reserved.

Topics

• Adnexal Diseases (complications, surgery)
• Adolescent
• Adult
• Case-Control Studies
• Female
• Humans
• Hysterectomy (adverse effects)
• Laparoscopy (adverse effects)
• Middle Aged
• Ovarian Torsion
• Retrospective Studies
• Risk Factors
• Young Adult