Minimal surgery for the twisted ischaemic adnexa can preserve ovarian function.
BACKGROUND
Recently detorsion has replaced salpingo-oophorectomy as treatment for the twisted ischaemic adnexa. This paper asssess whether the ovary resumes normal function after preservation by detorsion.


METHODS
The results of detorsion performed between January 1988 and December 2001 were retrospectively analysed. Post-operative complications and subsequent ovarian function were assessed including: ultrasound monitoring of follicular development, adnexal appearance during subsequent surgery, and the outcome of IVF.


RESULTS
A total of 102 detorsions were performed; 67 by laparoscopy, 35 by laparotomy. No patient developed thromboembolism. Post-operative fever occurred in 15% of patients after laparoscopy and 29% after laparotomy (P < 0.01). Patients were hospitalized for a mean (+/- SD) of 2.1 +/- 1.2 and 7.4 +/- 1.5 days after laparoscopy and laparotomy respectively (P < 0.001). Ultrasound showed normal follicular development in 93 and 91% of patients after detorsion by laparoscopy and laparotomy respectively. At subsequent surgery, the adnexa appeared normal in nine out of nine patients after laparoscopy and in four out of five patients after laparotomy. Four patients of the laparoscopy group and two patients of the laparotomy group underwent subsequent IVF. In all six patients oocytes retrieved from the previously ischaemic ovary were fertilized.


CONCLUSIONS
Detorsion with adnexal sparing is the treatment of choice for twisted ischaemic adnexa, and preferably performed by laparoscopy.
Oelsner
Gabriel
G
Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel. goelsner@sheba.health.gov.il
Cohen
Shlomo B
SB
Soriano
David
D
Admon
Dahlia
D
Mashiach
Shlomo
S
Carp
Howard
H
D015746:Abdominal Pain; D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D005298:Fertility; D005307:Fertilization in Vitro; D006801:Humans; D007511:Ischemia; D010535:Laparoscopy; D009865:Oocytes / Q000502:physiology; D010049:Ovarian Diseases / Q000175:diagnosis / Q000601:surgery*; D010053:Ovary / Q000098:blood supply* / Q000503:physiopathology*; D012189:Retrospective Studies; D014102:Torsion Abnormality