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Ovarian salvage following adnexal torsion in pediatric patients
Andrew Mudreac1,2, Spencer E Kim3, Rosa Hwang1
1Division of General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
Insights
Ovarian salvage through detorsion is preferred over oophorectomy for pediatric ovarian torsion. This study shows improved ovarian salvage rates with no negative outcomes, supporting current guidelines for preserving ovarian function in children.
Area of Science:
- Pediatric Surgery
- Gynecology
- Reproductive Health
Background:
- Ovarian torsion is a gynecologic emergency in children.
- The American Pediatric Surgical Association (APSA) recommends ovarian detorsion over oophorectomy.
- Institutional outcomes following these recommendations require evaluation.
Purpose of the Study:
- To evaluate institutional ovarian salvage rates and outcomes.
- To compare results before and after the 2017 APSA guidelines.
- To assess the safety and efficacy of ovarian detorsion in pediatric patients.
Main Methods:
- Retrospective review of electronic medical records (01/01/2010-12/31/2023).
- Inclusion of pediatric patients undergoing operative intervention for adnexal torsion.
- Exclusion of patients with antenatal torsion; analysis of patient characteristics, operative findings, and postoperative outcomes.
Main Results:
- 238 patients included; mean age 10.9 years.
- Ovarian detorsion performed in 78.2% (186/238) of cases.
- Oophorectomy in 21.8% (52/238), with necrosis or tumor in most cases; no intraoperative complications or thromboembolic events post-detorsion.
Conclusions:
- Ovarian salvage is the preferred treatment for pediatric ovarian torsion.
- Institutional ovarian salvage rates improved over the study period.
- Ovarian detorsion demonstrated successful outcomes with no missed malignancies or adverse sequelae.
Purpose:
In 2017, the American Pediatric Surgical Association (APSA) published a systematic review that supported ovarian detorsion rather than oophorectomy for children with ovarian torsion. We evaluated our institutional ovarian salvage rate and outcomes following ovarian detorsion before and after publication of these APSA recommendations.
Methods:
Electronic Medical Record data for patients who underwent operative intervention for adnexal torsion and between 01/01/2010 and 12/31/2023 at a single pediatric center were reviewed. Patients with antenatal torsion were excluded. Patient characteristics, operative findings, and postoperative outcomes were examined.
Results:
A total of 238 patients were included. Mean age was 10.9 years (range 0.1-20.0). Mean time from presentation to OR was 9.5 h (SD 8.9). Ovarian detorsion was performed in 186 patients (78.2%). Oophorectomy was performed in 52 (21.8%); of these, 33 (63.5%) demonstrated evidence of necrosis and 14 (26.9%) were associated with a tumor. There were no intraoperative complications. There were no thromboembolic events following detorsion. Pregnancy data were available for 10 patients, with 7 live births.
Conclusion:
Ovarian salvage is the preferred treatment for torsion. Our rates of ovarian salvage have improved over the past 10 years with no negative sequelae and no missed malignancies.
