Laparoscopy versus laparotomy for detorsion and sparing of twisted ischemic adnexa.
BACKGROUND
Torsion of the ovary is an urgent event for fertile women. Until recent years, the common treatment for twisted ischemic ovaries was salpingo-oophorectomy. We have demonstrated in the past that the ovary can be salvaged provided detorsion is performed. We studied the outcome of women undergoing minimal surgery for ischemic ovaries versus the extended procedure including cystectomy in respect of ovarian function and fertility performance.


METHODS
We retrospectively studied 102 women who underwent surgery for torsion of the ovary in which the macroscopic appearance of black-bluish ischemic adnexa was encountered during surgery. Detorsion without removal of the adnexa or the ovary was performed by laparoscopy in 67 patients and by laparotomy in 35 patients. Patients' files were reviewed for immediate and late outcomes. Patients were examined postoperatively with vaginal ultrasound for ovarian follicular function. Data concerning patients' further surgeries or in vitro fertilization were retrieved from the charts as well.


RESULTS
Febrile morbidity was approximately 15% and 29% in the laparoscopy and laparotomy groups, respectively. Hospital stay was 2.1 +/- 1.2 and 7.4 +/- 1.5 days in the laparoscopy and laparotomy groups, respectively (P<0.001). Ultrasound follow-up was available in 60 of 67 patients who underwent laparoscopy and in 32 of 35 patients treated by laparotomy. Normal-sized ovaries with follicular development were encountered in the detorsed side in 93% and 91%, respectively. Normal macroscopic appearance of the adnexa at subsequent surgeries was reported in 9 of 9 patients in the laparoscopy group and in 4 of 5 patients in the laparotomy group. Four patients from the laparoscopy group and 2 from the laparotomy group underwent subsequent in vitro fertilization. In all 6 patients, oocytes retrieved from the previously detorsed ovary were fertilized. In both groups, none of the patients developed clinical signs of pelvic or systemic thromboembolism.


CONCLUSIONS
Torsion of the ischemic adnexa should be treated laparoscopically by detorsion and adnexal sparing.
Cohen
Shlomo B
SB
Department of Obstetrics, Gynecology and Reproductive Medicine, Polyclinique de l'Hotel-Dieu, Clermont-Ferrand Cedex 1, France. s_cohen_eylon@hotmail.com
Wattiez
Arnaud
A
Seidman
Daniel S
DS
Goldenberg
Mordechai
M
Admon
Dahlia
D
Mashiach
Shlomo
S
Oelsner
Gabriel
G
D000291:Adnexal Diseases / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005298:Fertility / Q000502:physiology*; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods; D007813:Laparotomy / Q000379:methods; D010049:Ovarian Diseases / Q000503:physiopathology / Q000601:surgery; D010053:Ovary / Q000098:blood supply* / Q000502:physiology; D012189:Retrospective Studies; D014102:Torsion Abnormality