Reoperation Rates and Pain-Related Outcomes Following Hysterectomy in Pathologically Confirmed Endometriosis: Impact of Oophorectomy Status

Ali Salmanpour, Salmanpour A, Kaur P, Paramdeep Kaur, Alicia J. Long, Long AJ, Alexandra Lukey, Lukey A, Jessica N. McAlpine, McAlpine JN, Kathryn Mcrae, McRae K, Allaire C, Catherine Allaire, Kwon JS, Janice S. Kwon, Paul J. Yong, Yong PJ, Hanley GE, Gillian E. Hanley
Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC · 2026 · pp. 103562 · doi:10.1016/j.jogc.2026.103562 · PMID:42962755 · W7224817001
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In pathologically confirmed endometriosis patients, hysterectomy with bilateral salpingo-oophorectomy reduced reoperation rates compared to ovarian conservation but did not improve postoperative physician visits or pain medication prescriptions.

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Abstract

OBJECTIVE: To evaluate how oophorectomy during a hysterectomy for endometriosis impacts reoperation rates and pain-related healthcare services in a cohort of histopathologically confirmed endometriosis cases. METHODS: In this population-based retrospective cohort study, we included 990 cases of pathologically confirmed endometriosis in people aged 19-50 years who underwent hysterectomy between 2001 and 2016. The primary outcome was reoperation, and secondary outcomes included physician visits as well as filling prescriptions for opioids, oral contraceptive pills (OCP), and endometriosis medications within the 3-12 months after surgery. Kaplan-Meier curves and Cox proportional hazards were used. RESULTS: Compared to hysterectomy with ovarian conservation, hysterectomy with oophorectomy was associated with lower rates of reoperations (19.2% for hysterectomy with ovarian conservation vs 13.2% for hysterectomy with unilateral salpingo-oophorectomy and 4.9% for hysterectomy with bilateral salpingo-oophorectomy; aHR= 0.56, 95%CI= (0.36-0.88) and aHR= 0.20, 95%CI= (0.12-0.35), respectively). Pelvic peritoneal adhesions, recurrence of endometriosis, and endometrioma were the most common reasons for reoperations. No differences were observed between ovarian conservation versus bilateral oophorectomy in terms of physician visits, as well as opioid, OCP, and endometriosis medication dispensations within three to 12 months after surgery. HRT was filled in only 67.2% of those who entered premature surgical menopause CONCLUSION: Undergoing hysterectomy with bilateral salpingo-oophorectomy resulted in a lower rate of reoperation in this cohort of pathologically confirmed endometriosis patients. However, the number of physician visits for endometriosis or pelvic pain, or the rate of pain medication prescriptions, did not suggest an improvement for those who underwent hysterectomy with bilateral salpingo-oophorectomy.

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