Adnexectomy - Procedure and Side Effects

Introduction

An adnexal mass is a growth that forms in the pelvic region of women. It occurs near the uterus, usually in the fallopian tubes, ovaries, or connective tissues. These growths can develop from the reproductive system or nearby organs like the urinary bladder or intestines. The common cause of adnexal masses is ectopic pregnancy. Ectopic pregnancy is where the fertilized egg implants and grows in areas other than the uterus (most commonly in the fallopian tubes). Other most common types of adnexal masses are:

• Functional ovarian cysts (cysts that form on the surface of the ovary after ovulation).

• Polycystic ovaries (multiple cysts on enlarged ovaries).

• Benign tumors.

• Pelvic inflammatory diseases.

• Endometriosis (this is a condition where cells similar to the uterine lining grow outside the uterus).

What Is Adnexectomy?

An adnexectomy removes one or both of the fallopian tubes (salpingectomy) or one or both ovaries (oophorectomy). In some cases, fallopian tubes and ovaries are removed (salpingo-oophorectomy). An adnexectomy can be a salpingectomy, oophorectomy, or salpingo-oophorectomy. This procedure is last resort in treating conditions like ovarian cancer, pelvic infection, ectopic pregnancy, endometriosis, and benign tumors or cysts.

What Are Oophorectomy, Salpingectomy, and Salpingo-Oophorectomy?

• Oophorectomy - An oophorectomy is a surgical procedure to remove one or both ovaries. Ovaries are almond-shaped organs on each side of the uterus in the pelvic region. It contains eggs and produces hormones that control the menstrual cycle. Oophorectomy involving removal of both ovaries, it is called a bilateral oophorectomy. And when the procedure involves removing only one ovary, it is called unilateral oophorectomy. It can also be done as a part of a hysterectomy (an operation performed to remove the uterus).

• Salpingectomy - Salpingectomy is a surgical procedure in which the woman's fallopian tubes are removed. The fallopian tube is a portion of the female reproductive tract on the top and either side of the uterus. They act as a pathway for the eggs to reach the uterus during fertilization. Unilateral salpingectomy involves the removal of one fallopian tube, and bilateral salpingectomy involves the removal of both fallopian tubes.

• Salpingo-Oophorectomy - Salpingo-oophorectomy is a procedure to remove ovaries and fallopian tubes. Removal of an ovary and fallopian tube is called salpingo-oophorectomy, and when both ovaries and fallopian tubes are removed, it is called a bilateral salpingo-oophorectomy.

When Is Adnexectomy Recommended?

Adnexectomy is recommended for patients who require treatment for ovarian cancer, benign cyst or tumors, endometriosis, ovarian torsion (a condition when the ovary twist on the tissues that hold them), ectopic pregnancy, and in cases of pelvic infection. It is also performed as a means to reduce the risk of breast and ovarian cancers in high-risk women, especially those with BRCA gene mutation. When a BRCA gene mutation is present in a person, they are at a higher risk of developing ovarian or breast cancer than the rest.

How to Prepare for Adnexectomy Procedure?

• Before the surgery, the healthcare provider will review the procedure with the patient and give pre and post-operative surgical care instructions.

• Instructions can vary depending on the age and any other underlying medical conditions.

• The doctor also recommends stopping eating food a few hours before the surgery and limiting the liquid intake.

• The doctor might also ask the patient to stop taking certain medications.

• Sometimes, imaging tests like blood tests or ultrasounds are required by surgeons for procedure and planning.

• If bilateral salpingo-oophorectomy is performed, then the patient will no longer get periods or be able to get pregnant. After the surgery, the patient might reach full menopause, and the sudden loss of estrogen can have other effects on the body.

• The patient needs to discuss with the doctor the possible effects the surgery can cause and suggest ways to prepare for the changes the patient might experience.

How Is Adnexectomy Performed?

An adnexectomy can be performed in three ways.

• Open Abdomen Adnexectomy - This traditional surgical method requires general anesthesia. In this procedure, the surgeon makes a long incision in the lower abdomen to access the ovaries and fallopian tubes. The incision is then stitched or stapled and closed. The surgeon then does unilateral or bilateral removal of ovaries or fallopian tubes.

• Minimally Invasive Laparoscopic Surgery - This surgery is performed under local or general anesthesia. The laparoscope is a small tube with a camera and a light for the surgeon to see the pelvic organs inside without making large incisions. This camera transmits video onto a monitor in the operation room, and the surgeon uses this video to guide the surgical tools. A few small incisions are made. The video laparoscope (camera) is inserted through one incision, and laparoscopic instruments are inserted into the other. One or both of the ovaries or one or both of the fallopian tubes are removed through the small incision, and finally, the incisions are closed.

• Robotic Surgery - This surgery is also done with small incisions. Here, the surgeon uses a robotic arm instead of a laparoscope. The robotic arm is attached to a camera for high-definition visualization. The surgeon moves the robotic arm precisely, and ovaries and fallopian tubes are located and removed. The incisions are then closed.

What Are the Commonly Seen Side Effects or Risks Associated With Adnexectomy?

• The most common risks seen in the surgery include infection and internal organ damage.

• Adhesive small bowel obstructions are seen in the case of laparoscopic surgeries.

• Injuries to the ureter at the infundibulopelvic ligament level are also possible.

• In an oophorectomy, the most harmful side effect is the loss of hormones released by the ovaries. Women who undergo bilateral oophorectomy lose their ability to produce estrogen and progesterone hormones and half their ability to produce testosterone.

• Due to the hormone deficiency, women who undergo oophorectomy enter a phase called surgical menopause. Surgical menopause is different than normal menopause. Normal menopause occurs naturally as an aging process in women.

• In most cases, adnexectomy is combined with hysterectomy, which leads to an inability to get pregnant and have a child. In a unilateral adnexectomy, the remaining ovary can produce eggs, so chances of getting pregnant naturally are possible. In the case of bilateral adnexectomy, natural conception is not possible.

Conclusion

Adnexectomy can be either a salpingectomy, oophorectomy, or salpingo-oophorectomy. It is also done alongside a hysterectomy. It is usually recommended for patients who require treatment for ovarian cancer, benign cysts, tumors, or endometriosis. The surgeon considers factors like the patient's age, pre or post-menopausal status at the surgery, and the ratio of removal versus a conservative treatment before suggesting the surgery.