A New Technique of Oophoropexy: Folding and Fixating of Utero-Ovarian Ligament to Round Ligament in a Patient with Reccurrent Ovarian Torsion

Abstract

Introduction Most cases of ovarian torsion occur in the reproductive age and many are related to ovarian and paraovarian masses. If it occurs without any subtle anatomic etiology or ovarian and paraovarian masses, recurrence of ovarian torsion is more likely. Recurrent left ovarian torsion is much less common than recurrent right ovarian torsion. The authors describe a rare case with their new ovarian fixation technique. Case and Method A 21-year-old female patient with polycystic ovarian syndrome had a 7th recurrence of left ovarian torsion. Although ovarian fixation was performed in addition to detorsion at the 5th and the 6th laparoscopic surgeries, it had failed. Due to recurrence ovarian torsion after ovarian fixation, the authors performed a different technique:folding the utero-ovarian ligament which folded on itself. The distal part of the utero-ovarian ligament with the ovary was both fixed to the proximal part of the round ligament which was adjacent to the uterus. Conclusion Although a wide range of oophoropexy methods have been described in the literature, the best method remains a matter for debate. This technique can be performed even when the ovarian tissue is necrotic. Because of this, we think that this technique is useful and effective technique.

Ovarian Ligament Plication as a Treatment for Patient with Elongated Ovarian Ligament with Recurrent Abdominal Pain in the Absence of Ovarian Torsion

“…Recurrent right ovarian torsion is more common than the left side. [ 3 4 ] Rangaram et al . [ 1 ] reported a case of left adnexal torsion associated with left corpus luteal cyst.…”

“…The majority of the cases occur in enlarged ovaries such as polycystic ovaries, ovarian cysts, para-ovarian cysts, or hyperstimulated ovaries preventing the return to the normal position after torsion. [ 3 5 ] Most of the cases with ovarian cysts or polycystic ovaries do not undergo torsion, which indicates the probability of other causes for the torsion. Further, torsion may occur in the presence of normal ovaries.…”

“…Recurrence of ovarian torsion is more common in the absence of anatomic abnormality. [ 3 ] Ovarian torsion in adolescents or premenarcheal girls who have elongated infundibulopelvic ligament can occur without any ovarian cyst or mass. [ 6 7 8 ] In our case, ovaries were normal and the patient is an adolescent female.…”

“…[ 2 ] Ovarian torsion is an emergency as, if left untreated, it may lead to ovarian necrosis. [ 3 ] The majority of the cases of ovarian torsion occur in the presence of ovarian or para-ovarian masses. [ 1 ] We report a case of recurrent abdominal pain, especially after exercise, with elongated ovarian ligament and relief of pain with ovarian ligament plication in the absence of ovarian torsion or ovarian mass.…”

Adnexal torsion in pregnancy after in vitro fertilization

“…Recurrent adnexal torsion can also be prevented by adnexal detorsion and shortening the utero-ovarian ligament. [ 15 , 21 ] Seven cases of ovarian torsion were reported by Hosny et al [ 22 ] ; 2/7 cases had OHSS, and 50% of the patients showed clinical symptoms and hemorrhagic cysts. Fortunately, there was no recurrence in these 2 patients, who underwent detorsion and oophoropexy.…”