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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.
Journal of Pediatric and Adolescent Gynecology
|November 30, 2016
Summary
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.
