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Ovarian remnant syndrome after laparoscopic oophorectomy
C H Nezhat1, D S Seidman, F R Nezhat
1Department of Gynecology and Obstetrics, Stanford University School of Medicine, California, USA. info@Nezhat.com
Objective:
To report the surgical history, clinical characteristics, and operative technique used in patients with ovarian remnant syndrome after laparoscopic oophorectomy.
Design:
Observational study.
Setting:
Teaching hospital and private practice office.
Patient(S):
Nineteen patients with documented history of unilateral or bilateral laparoscopic oophorectomies with histologic confirmation of ovarian remnants.
Intervention(S):
Operative laparoscopy for resection of ovarian remnants.
Main Outcome Measure(S):
Risk factors and surgical technique contributing to ovarian remnant syndrome.
Result(S):
The patients underwent a mean of 4.7 previous surgical procedures (range, two to nine): 12 had bilateral oophorectomy, and seven had unilateral oophorectomy. The infundibulopelvic ligament had been secured with bipolar desiccation in 11 patients, pretied surgical loops in six, and a linear stapler in two. Cystic ovarian remnants were identified by pelvic sonography in 12 women and by computed tomography (CT) scan in one. Six women underwent reoperation, two for ovarian remnants in different sites.
Conclusion(S):
With laparoscopic oophorectomy there is risk of ovarian remnant due to improper tissue extraction or misapplication or improper use of pretied surgical loops, linear stapler, or bipolar electrodesiccation on the infundibulopelvic ligament, especially in women with a history of multiple pelvic surgeries, adhesions, or endometriosis.