Rates and Technique for Oophoropexy in Pediatric Ovarian Torsion: A Single-Institution Case Series

Comeau, Ian; Hubner, Nicole; Kives, Sari; Allen, Lisa

doi:10.1016/j.jpag.2016.11.006

Cited by 28 publications

(11 citation statements)

References 28 publications

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“…Gonadopexy (oophoropexy) after detorsion can be considered, especially with previous oophorectomy and the presence of unilateral torted ovary . However, it is important to note that oophoropexy does not completely prevent ovarian torsion …”

Section: Managementmentioning

confidence: 99%

Management of ovarian cysts in children and adolescents

Potdar

Pillai

Oppenheimer

2020

The Obstetric & Gynaecologis

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Key content Most ovarian cysts in children and adolescents are benign. Incidence of large ovarian cysts usually peaks in the first year of life and around menarche; approximately 30% of girls will present with pain. Gynaecologists, paediatric surgeons and general surgeons may manage ovarian cysts. There is a lack of standardised protocols and guidance, so most patients are managed on the basis of an individual clinician’s judgement, preference and experience. Whenever possible, the operation of choice for benign cysts is laparoscopic ovarian cystectomy with ovarian preservation. This review provides an evidence‐based tool for the management of ovarian cysts in children and adolescent girls. Learning objectives To identify ovarian pathology using appropriate imaging in emergency and elective situations. To know that, when possible, a multidisciplinary approach between gynaecologists, radiologists and paediatric surgeons is optimal. To be vigilant for malignant tumours and perform ovarian‐sparing surgery for suspected benign conditions. Ethical issues There are long‐term reproductive consequences of inadvertently removing one or both ovaries. Unnecessary surgery has an effect on patients’ physical and mental wellbeing.

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Section: Managementmentioning

confidence: 99%

Management of ovarian cysts in children and adolescents

Potdar

Pillai

Oppenheimer

2020

The Obstetric & Gynaecologis

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“…In an 11-case series, Comeau et al reported that oophoropexy was evaluated on a case-by-case basis at the discretion of the senior surgeon, oophoropexy was performed for the first, second or third torsion [ 23 ]. The cases in this series were also evaluated individually.…”

Section: Discussionmentioning

confidence: 99%

How can the risk of ovarian retorsion be reduced?

Mehmetoğlu

2018

J Med Case Reports

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BackgroundIn the current treatment of idiopathic ovarian torsion, the use of oophorectomy has declined in favor of preserving the ovary. This approach brings with it the question of how to reduce the possibility of retorsion of the detorsioned ovary. The aim of this study was to analyze how retorsion can be prevented.MethodsFive patients (a 30-day-old Caucasian girl, a 55-day-old Caucasian girl, an 8-year-old Caucasian girl, a 10-year-old Caucasian girl, and a 16-year-old Caucasian girl) who underwent surgery due to non-neoplastic ovarian torsion were retrospectively analyzed for diagnosis and treatment in terms of reducing the possibility of retorsion.ResultsIn all patients, a precise diagnosis of idiopathic unilateral ovarian torsion was made during laparotomy, and the patients underwent different procedures. The ovary was found to be autoamputated in one patient, and two patients underwent salpingo-oophorectomies due to adnexal necrosis. The ovaries were detorsioned in the remaining two patients. During the operations, patients were evaluated regarding the prevention of retorsion of the ipsilateral and/or contralateral ovary; cyst drainage, cystectomy, ligament fixation, and/or oophoropexy were performed. The median follow-up period of the patients was 2 years (range 1.5–6 years), and they continue to be followed uneventfully.ConclusionsTo date, there is no standard approach to protect the ovary from retorsion in patients who undergo surgery due to torsion. The surgical procedure should be tailored on a case-by-case basis.

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“…One case of adnexal torsion in this study was managed by oopexy after detorsion and aspiration of a simple ovarian cyst. Evidence shows that there is an ongoing risk of recurrent adnexal torsion even after adnexal fixation [ 22 ]. Also, in the presence of a benign adnexal lesion, there is no significant difference in recurrence risk after oopexy compared to detorsion plus fenestration or resection of the lesion [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Missed opportunities for ovarian salvage in children: an 8-year review of surgically managed ovarian lesions at a tertiary pediatric surgery centre

et al. 2021

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Introduction The aetiology and management of ovarian pathology in children differs between antenatal and postnatal lesions. However, all lesions may present acutely due to adnexal torsion. In this setting, opportunities to preserve fertility with ovary-sparing surgery (OSS) may be missed. Some studies suggest that pediatric and adolescent gynaecology (PAG) input in care is associated with OSS. Methods A retrospective cohort study of children undergoing surgery for ovarian pathology at a tertiary pediatric surgery centre over an 8-year period (2011–2018). Patient factors, lesion characteristics and PAG involvement were examined for association with OSS using multivariate logistic regression. Results Thirty-five patients with ovarian pathology managed surgically were included. Ten were infants with lesions detected antenatally; all were managed by pediatric surgeons (PS) alone at median age 2 weeks (1 day–25 weeks). Twenty-five patients presented postnatally at median age 11 (0.75–15) years. In total, there were 16 cases of adnexal torsion, each managed primarily by PS. Twelve underwent oophorectomy and six (50%) of these cases had viable ovarian tissue on histology. Furthermore, two infants with large simple cysts were similarly managed by unnecessary oophorectomy based on histology. Overall rate of OSS was 46% and PAG involvement was the only factor associated with ovarian salvage. Conclusion Differences in surgical management between PAGs and PS may be attributable to the different patient populations they serve. We recommend improving the knowledge of PS trainees in OSS approaches for adnexal torsion and large benign lesions.

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Rates and Technique for Oophoropexy in Pediatric Ovarian Torsion: A Single-Institution Case Series

Cited by 28 publications

References 28 publications

Management of ovarian cysts in children and adolescents

Management of ovarian cysts in children and adolescents

How can the risk of ovarian retorsion be reduced?

Missed opportunities for ovarian salvage in children: an 8-year review of surgically managed ovarian lesions at a tertiary pediatric surgery centre

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