Should the ovary always be conserved in torsion? A tertiary care institute experience

Parelkar, Sandesh; Mundada, Dinesh; Sanghvi, Beejal; Joshi, Prashant; Oak, Sanjay; Kapadnis, Satish P.; Shetty, Shishira; Athawale, Hemangi R.; Multani, Pooja

doi:10.1016/j.jpedsurg.2013.11.055

Cited by 74 publications

(35 citation statements)

References 17 publications

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“…8,12,13,40 Several case series demonstrate that nearly all ovaries that previously appeared necrotic on gross examination at the time of detorsion, subsequently appeared normal postoperatively, with follicle development on transvaginal ultrasound. [11][12][13]34,[41][42][43] A histological study of rat ovaries following varying degrees of ischaemia found that blue or black macroscopic appearance, which is likely secondary to venous congestion and lymphatic stasis with initial occlusion of the ovarian vein, did not correlate with histological findings or viability of ovarian tissue following reperfusion. 9 Even ovaries that had been ischaemic for up to 24 hours were found to be viable following reperfusion, with true necrosis and peritonitis only occurring following ≥36 hours of ischaemia.…”

Section: Interpretationsmentioning

confidence: 99%

Conservative surgery for ovarian torsion in young women: perioperative complications and national trends

Mandelbaum

Smith

Roman

et al. 2019

Fertility and Sterility

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Objective To analyse populational trends and perioperative complications following conservative surgery versus oophorectomy in women <50 years of age with ovarian torsion.Design Population-based retrospective observational study.Setting Nationwide Inpatient Sample in the USA (2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015).Population In all, 89 177 ovarian torsions including 20 597 (23.1%) conservative surgeries and 68 580 (76.9%) oophorectomies.Methods (1) Trend analysis to assess utilisation of conservative surgery over time, (2) multivariable binary logistic regression to identify independent factors associated with conservative surgery and (3) inverse probability of treatment weighting with a generalised estimating equation to analyze perioperative complications.Main outcome measures Trends, characteristics and complications related to conservative surgery.Results Performance of conservative surgery increased from 18.9 to 25.1% between 2001 and 2015 (32.8% relative increase, P = 0.001) but decreased steadily after age 15, and sharply declined after age 35 (P < 0.001). On multivariable analysis, younger age exhibited the largest effect size for conservative surgery among the independent factors (adjusted odds ratios 3.39-7.96, P < 0.001). In the weighted model, conservative surgery was associated with an approximately 30% decreased risk of perioperative complications overall (10.0% versus 13.6%, odds ratio 0.73, 95% confidence interval 0.62-0.85, P < 0.001) and was not associated with venous thromboembolism (0.2 versus 0.3%, P = 0.457) or sepsis (0.4 versus 0.3%, P = 0.638).Conclusion There has been an increasing utilisation of conservative surgery for ovarian torsion in the USA in recent years. Our study suggests that conservative surgery for ovarian torsion may not be associated with increased perioperative complications.Tweetable abstract Conservative surgery for ovarian torsion may not be associated with increased perioperative complications.

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Section: Interpretationsmentioning

confidence: 99%

Conservative surgery for ovarian torsion in young women: perioperative complications and national trends

Mandelbaum

Smith

Roman

et al. 2019

Fertility and Sterility

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“…Most studies quoted more than 90% of ovarian salvage. 2,7,11 Mc Govern et al 12 presented scientific analysis of 981 cases of ovarian torsion described only two cases (0.02%) of pulmonary embolism coincidental with ovarian vein thrombosis in a case of adnexal torsion. Interestingly both cases occurred in the adnexal resection group and not in the detorsion group.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic detorsion of gangrenous adnexae followed by interval cystectomy: case report and review of the literature

Ramli

Mansor

Abdullah

et al. 2015

Int J Reprod Contracept Obstet Gynecol

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“…Size > 5 cm 9 2 Volume > 20 times x opposite normal ovary 9 2 Table 5 DISCUSSION Torsion of the ovary is the cause of 2.7% of all acute abdominal pain in children. 6,7 Most cases of ovarian torsion occur in the reproductive age group 8 and only 15-20% occurs in children. Unlike the adult population, 25-68% of paediatric ovarian torsions are that of normal ovary.…”

Section: Torsion Of Normal Ovarymentioning

confidence: 99%

“…Untwist and retain the ovary even in the visibly "necrotic" cases, because it is impossible to predict the chances of the ovary reviving after detorsion. 6,7,26,27 The dark haemorrhagic oedematous appearance of the torsed adnexa is the result of ovarian engorgement, secondary to venous stasis. Complete arterial obstruction probably does not occur in most cases.…”

Section: Torsion Of Normal Ovarymentioning

confidence: 99%

Paediatric Ovarian Torsion- Salvaging the Unsalvageable

Vasudevan¹,

Sadiq²

2019

jebmh

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BACKGROUND Ovariectomy used to be the conventional treatment for ovarian torsion in the paediatric age group. A paradigm shift in the management of paediatric ovarian torsion was reported in recent years, with ovarian recovery documented with simple detorsion, even for cases which macroscopically appeared necrotic or gangrenous. Our study was undertaken to analyse the management and outcome after detorsion of twisted ovaries in children. METHODSA prospective study of 20 consecutive cases of paediatric ovarian torsions that presented in a tertiary level Paediatric Surgery Dept. from 2010 to 2014 was done. Neonatal and infantile cases were excluded. Pre-operative parameters (age, symptoms and duration, menarchal status, sonographic features, doppler assessment of flow, tumour markers, time to surgery from presentation at hospital) and per-operative parameters (site, size, appearance, colour and response to detorsion) were assessed. The cases were categorized into 3 groups-Group A-Detorsion with or without aspiration. Group B-Detorsion with immediate ovarian sparing cystectomy. Group C-Ovariectomy. Post-operatively, patients were followed up clinically and with sonograms. RESULTSIn all cases of Group A and B, the ovary could be salvaged as documented with sonograms, irrespective of the initial macroscopic appearance of the ovary. All cases in group B, where cystectomy was done along with the initial detorsion, had smaller ovaries in follow up sonograms. There were no cases of ovarian malignancy undergoing torsion. 55% of cases were that of normal ovary undergoing torsion. In ovarian torsions, where the size was more than 5 cms and/or volume of the involved side was more than 20 times that of the opposite normal ovary, 82% had an associated cyst/benign lesion at the time of torsion. CONCLUSIONSOvarian preservation should be the basic tenet of surgical approach irrespective of the pre-operative Doppler findings and intra-operative color of the twisted ovary.

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Should the ovary always be conserved in torsion? A tertiary care institute experience

Cited by 74 publications

References 17 publications

Conservative surgery for ovarian torsion in young women: perioperative complications and national trends

Conservative surgery for ovarian torsion in young women: perioperative complications and national trends

Laparoscopic detorsion of gangrenous adnexae followed by interval cystectomy: case report and review of the literature

Paediatric Ovarian Torsion- Salvaging the Unsalvageable

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