Laparoscopy versus laparotomy for surgical intervention of ovarian torsion.
OBJECTIVE
To review the clinical manifestations of ovarian torsion (OT) and to compare the surgical results between laparoscopy and laparotomy.


METHODS
From 1997 to 2006, data on 179 patients admitted to a medical center with surgically proven OT were collected. We compared patients' symptom presentations, objective findings and surgical outcomes between patients who underwent laparotomy and those who received laparoscopy, and between patients admitted via the emergency room and those via the outpatient department.


RESULTS
The most common symptom and sign was pelvic pain (82.1%), followed by nausea and vomiting (49.7%), elevated white blood count (20.1%), lower urinary tract symptoms (14.5%) and fever (7.8%). An adnexal or pelvic mass could be detected using gynecological ultrasound in almost all of the patients (98.3%). Ovarian torsion was considered among the admission differential diagnoses in 51.4% of patients. One hundred and five patients (58.7%) seen in the emergency room were more likely to present with nausea and vomiting, sudden pain onset and peritoneal signs than those seen in the outpatient department. Patients undergoing laparoscopy had a smaller sized ovarian mass; they were less likely to require oophorectomy; they had a shorter hospital stay; and fewer of them suffered from postoperative fever compared to patients undergoing laparotomy. Discriminant analysis showed that mass size was the single determining factor for choice of operating methods.


CONCLUSIONS
The diagnosis of OT is missed in half of the patients because clinical features are unspecific and objective findings are uncommon. The laparoscopy procedure for ovarian conservation is recommended to treat patients suffering from OT owing to its shorter hospital stay, fewer postoperative complications and ovarian preservation.
Lo
Liang-Ming
LM
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Taoyuan, Taiwan.
Chang
Shuenn-Dhy
SD
Horng
Shang-Gwo
SG
Yang
Ting-Yu
TY
Lee
Chyi-Long
CL
Liang
Ching-Chung
CC
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000379:methods; D007813:Laparotomy / Q000379:methods; D008875:Middle Aged; D010049:Ovarian Diseases / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D014102:Torsion Abnormality / Q000473:pathology / Q000601:surgery*; D055815:Young Adult