title: Laparoscopic excision of ovarian remnants: retrospective cohort study with long-term follow-up.
abstract: OBJECTIVE
  To review the clinical presentation, surgical and pathologic findings, and long-term outcomes after excision of ovarian remnants using a predominantly laparoscopic approach.
  
  
  METHODS
  Retrospective medical record review and long-term follow-up via telephone interview (Canadian Task Force classification II-3).
  
  
  METHODS
  Large academic medical institution.
  
  
  METHODS
  Thirty women who underwent excision of pathologically confirmed ovarian remnants by a single surgeon between 2001 and 2009.
  
  
  METHODS
  Excision of ovarian remnants, 29 at laparoscopy and 1 at laparotomy.
  
  
  RESULTS
  Of the 30 patients, 29 had pain and 1 had a persistent adnexal mass. Of the 29 patients who underwent preoperative ultrasonography, 26 (89.6%) had an adnexal mass on the side of previous salpingo-oophorectomy. Masses ranged in size from 0.8 to 7.4 cm in greatest diameter and most commonly contained debris-filled cysts. Intraoperatively, 29 excisions (96.7%) required retroperitoneal dissection, 27 (90.0%) required enterolysis, 28 (93.3%) required ureterolysis, and 20 (66.7%) required ligation of the uterine artery at its origin. All pathology reports confirmed ovarian tissue, often associated with endometriosis, corpus luteal cysts, and simple cysts. Four bowel injuries and 2 bladder injuries were laparoscopically repaired by the primary surgeon. Three patients required bowel resections by a general surgeon. Records from postoperative visits were available for 28 patients, of whom 17 (60.7%) reported resolution of pain, 9 (32.1%) reported improvement, and 2 (7.1%) reported persistent pain. Of the 18 women who returned written consent for the telephone interview, 11 (61.1%) reported resolution of pain, 5 (27.8%) reported improvement, and 2 (11.1%) reported persistent pain.
  
  
  CONCLUSIONS
  While laparoscopic excision of ovarian remnants is feasible, the procedure almost always requires a retroperitoneal dissection and is associated with high risk of complications. Careful surgical planning and preparation are essential.
authors.affiliation: Division of Gynecologic Specialties, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA. deboraharden@gmail.com
authors.forename: Deborah
authors.initials: D
authors.lastname: Arden
authors.forename: Ted
authors.initials: T
authors.lastname: Lee
mesh_terms: D000291:Adnexal Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D000328:Adult; D015331:Cohort Studies; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D010535:Laparoscopy; D007813:Laparotomy; D010053:Ovary / Q000000981:diagnostic imaging / Q000601:surgery*; D017699:Pelvic Pain / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography