title: Adnexal masses requiring reoperation in women with previous hysterectomy with or without adnexectomy.
abstract: OBJECTIVE
  To characterize the etiologies of adnexal masses requiring reoperation in women with prior hysterectomy and to compare incidence and pathology of these masses based upon whether total, partial or no adnexectomy was performed at time of hysterectomy. In addition, the average time interval between hysterectomy and reoperation for a pelvic mass is ascertained.
  
  
  METHODS
  A single-institution, retrospective review spanning 10 years. Using pertinent ICD-9 and CPT codes, women with a history of hysterectomy who underwent a subsequent surgery for an adnexal or pelvic mass were identified.
  
  
  RESULTS
  Over ten years, 250 women returned for gynecologic surgery due to a pelvic mass after prior hysterectomy. Most had undergone hysterectomy only (76%). 64.8% of these women had masses of ovarian origin, 12.4% were tubal in origin, 20% of masses involved both the ovary and tube and a small proportion arose from non-gynecologic processes. 18% of these women had a malignancy; 80% were ovarian and 6.7% originated from the fallopian tube. Patients having had a prior hysterectomy and bilateral salpingectomy returned soonest (p<0.0001) and patients with malignant masses returned after the longest time intervals (HR 0.41, p<0.0001).
  
  
  CONCLUSIONS
  The majority of adnexal masses requiring reoperation after hysterectomy are gynecologic in origin, benign, and arise from the ovary. Women returning with malignant masses after hysterectomy present after longer time intervals.
authors.affiliation: University of Louisville School of Medicine, Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Louisville, KY 40202, United States. Electronic address: lindashiber@gmail.com.
authors.forename: Linda-Dalal J
authors.initials: LD
authors.lastname: Shiber
authors.affiliation: University of Louisville School of Medicine, Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Louisville, KY 40202, United States.
authors.forename: Emily J
authors.initials: EJ
authors.lastname: Gregory
authors.affiliation: University of Louisville School of Public Health and Information Sciences, Department of Bioinformatics and Biostatistics, Louisville, KY, United States.
authors.forename: Jeremy T
authors.initials: JT
authors.lastname: Gaskins
authors.affiliation: University of Louisville School of Medicine, Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Louisville, KY 40202, United States.
authors.forename: Shan M
authors.initials: SM
authors.lastname: Biscette
mesh_terms: D000291:Adnexal Diseases / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D005185:Fallopian Tube Neoplasms; D005187:Fallopian Tubes / Q000473:pathology; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000601:surgery; D010053:Ovary / Q000473:pathology; D012189:Retrospective Studies; D058994:Salpingectomy; D013997:Time Factors
keywords: Adnexal mass; Pelvic mass; Prior hysterectomy; Prophylactic salpingectomy; Reoperation; Salpingectomy at hysterectomy