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Pediatric Ovarian Torsion and its Recurrence: A Multicenter Study
Mirko Bertozzi1, Ciro Esposito2, Claudio Vella3
1S.C. di Clinica Chirurgica Pediatrica, Università degli Studi di Perugia, Ospedale S. Maria della Misericordia, Perugia, Italy.
Insights
Pediatric ovarian torsion (OT) management varies, with recurrence noted in 12% of cases, especially in patients without ovarian masses. Oophoropexy (OPY) is recommended for the first episode of OT to improve outcomes.
Area of Science:
- Pediatric Surgery
- Gynecology
- Reproductive Health
Background:
- Pediatric ovarian torsion (OT) is a gynecologic emergency requiring prompt diagnosis and management.
- Current management strategies for pediatric OT, including surgical interventions and recurrence prevention, are not standardized across all centers.
Purpose of the Study:
- To investigate the current management practices for pediatric ovarian torsion (OT) in Italy.
- To analyze the recurrence rates and outcomes associated with different surgical interventions for pediatric OT.
- To evaluate the effectiveness of oophoropexy (OPY) in preventing recurrence and preserving ovarian function.
Main Methods:
- Multicenter retrospective cohort study involving Italian Units of Pediatric Surgery.
- Analysis of 124 returned questionnaires detailing patient demographics, surgical procedures, and follow-up data for pediatric patients (aged 1-14 years) diagnosed with OT between 2004 and 2014.
- Evaluation of surgical interventions including adnexal detorsion, adnexectomy, and oophoropexy (OPY), with assessment of recurrence rates and 1-year ultrasonographic follow-up of detorsed ovaries.
Main Results:
- The study included 125 pediatric patients with surgically diagnosed OT.
- Common procedures included open adnexectomy (41.6%) and laparoscopic detorsion (30.4%).
- Recurrence of OT occurred in 12% of cases, significantly higher in patients with a normal ovary during the first episode (P=.012). Oophoropexy (OPY) was associated with a lower recurrence rate (5.2%).
Conclusions:
- Oophorectomy and open surgical techniques remain prevalent despite recommendations against them.
- Recurrence of pediatric ovarian torsion is a significant concern, particularly in cases without an initial ovarian mass.
- Oophoropexy (OPY) is a safe and effective technique that does not negatively impact ovarian function at 1-year follow-up and should be considered during the initial surgical management of OT.
Study Objective:
To report results of a retrospective multicentric Italian survey concerning the management of pediatric ovarian torsion (OT) and its recurrence.
Design:
Multicenter retrospective cohort study.
Setting:
Italian Units of Pediatric Surgery.
Participants:
Participants were female aged 1-14 years of age with surgically diagnosed OT between 2004 and 2014.
Interventions:
Adnexal detorsion, adnexectomy, mass excision using laparoscopy or laparotomy. Different kinds of oophoropexy (OPY) for OT or recurrence, respectively.
Main Outcome Measures:
A total of 124 questionnaires were returned and analyzed to understand the current management of pediatric OT and its recurrence. The questionnaires concerned patient age, presence of menarche, OT site, presence and type of mass, performed procedure, OPY technique adopted, intra- and postoperative complications, recurrence and site, procedure performed for recurrence, OPY technique for recurrence, and 1 year follow-up of detorsed ovaries.
Results:
Mean age at surgery was 9.79 ± 3.54 years. Performed procedures were open adnexectomy (52 of 125; 41.6%), laparoscopic adnexectomy (25 of 125; 20%), open detorsion (10 of 125; 8%), and laparoscopic detorsion (38 of 125; 30.4%). Recurrence occurred in 15 of 125 cases (12%) and resulted as significant (P = .012) if associated with a normal ovary at the first episode of torsion. Recurrence occurred only in 1 of 19 cases after OPY (5.2%). Ultrasonographic results of detorsed ovaries were not significant whether an OPY was performed or not (P = 1.00).
Conclusion:
Unfortunately, oophorectomy and open technique are still widely adopted even if not advised. Recurrence is not rare and the risk is greater in patients without ovarian masses. OPY does not adversely affect ultrasonographic results at 1 year. When possible OPY should be performed at the first episode of OT.
