title: Outcome of conservative laparoscopic surgery for adnexal torsion through one-stage or two-stage operation.
abstract: OBJECTIVE
  We investigated the outcome on ovarian appearance and occurrence of adhesion after conservative laparoscopic surgery for adnexal torsion during reproductive age.
  
  
  METHODS
  From April 2009 to September 2012, we treated patients with clinically suspected adnexal torsion who desired future pregnancy. We performed conservative surgery, such as cystectomy or detorsion at one-stage operation, but switched to salpingo-oophorectomy in complicated cases. We evaluated adnexal condition and pattern of adhesion by careful assessment with two-stage laparoscopy or second-look laparoscopy after first surgery.
  
  
  RESULTS
  Mean age of patients was 25 ± 8 years. Among 37 patients with suspected adnexal torsion, 18 (49%) had adnexal torsion at first surgery. Conservative treatment was carried out in 14 of 18 cases. We obtained informed consent for second-look laparoscopy or two-stage operation in six of these 14 cases. Among these six patients, two cases were treated with only detorsion by one-stage operation and cystectomy was performed in the other four cases at first operation. At subsequent surgery, the ovary appeared normal in six cases with occurrence of mild to moderate adhesion around the adnexal lesion. Of note, two cases with para-ovarian cyst had torsion that showed complete tubal occlusions and associated severe adhesions. No major complications (peritonitis, thrombotic emboli) were observed after conservative laparoscopic surgery.
  
  
  CONCLUSIONS
  Conservative laparoscopic surgery is a safe procedure to preserve ovarian function in women with adnexal torsion. Careful attention and measures should be considered during follow-up management with the fact in mind that adhesion is a common occurrence and even tubal occlusion may occur in some cases.
authors.affiliation: Department of Gynecology, Saiseikai Nagasaki Hospital, Nagasaki, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Fujishita
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Araki
authors.forename: Shiko
authors.initials: S
authors.lastname: Yoshida
authors.forename: Daisuke
authors.initials: D
authors.lastname: Hamaguchi
authors.forename: Daisuke
authors.initials: D
authors.lastname: Nakayama
authors.forename: Nobuo
authors.initials: N
authors.lastname: Tsuda
authors.forename: Khaleque Newaz
authors.initials: KN
authors.lastname: Khan
mesh_terms: D000291:Adnexal Diseases / Q000209:etiology / Q000601:surgery; D000293:Adolescent; D000328:Adult; D002648:Child; D018293:Cystadenoma, Serous / Q000150:complications / Q000601:surgery*; D005185:Fallopian Tube Neoplasms / Q000150:complications / Q000601:surgery*; D005260:Female; D059247:Fertility Preservation; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D010048:Ovarian Cysts / Q000150:complications / Q000601:surgery; D010051:Ovarian Neoplasms / Q000150:complications / Q000601:surgery*; D010053:Ovary / Q000000981:diagnostic imaging / Q000502:physiology; D024162:Second-Look Surgery; D013724:Teratoma / Q000150:complications / Q000601:surgery*; D000267:Tissue Adhesions / Q000209:etiology; D014102:Torsion Abnormality / Q000209:etiology / Q000601:surgery*; D055815:Young Adult
keywords: adnexal torsion; conservative surgery; detorsion; laparoscopic surgery; second-look laparoscopy