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Is the management of isolated tubal torsion in pediatric surgery appropriate? A multicenter european study and
Aurora Mariani1, Carmen Iulia Ciongradi2, Elisa Zambaiti3
1Department of Pediatric Surgery, CHU Angers, France.
Insights
Pediatric isolated fallopian tubal torsion (IFTT) management involves various surgical approaches. Detorsion is common, but tubal malformations or hydrosalpinx may necessitate further intervention to prevent recurrence and improve outcomes.
Area of Science:
- Pediatric Surgery
- Gynecologic Surgery
- Reproductive Medicine
Background:
- Isolated fallopian tubal torsion (IFTT) is a rare gynecologic emergency in children.
- Timely diagnosis and surgical intervention are crucial for preserving tubal function and preventing complications.
Purpose of the Study:
- To describe current surgical practices for pediatric IFTT.
- To identify optimal surgical procedures for IFTT management.
- To assess postoperative complications and recurrence rates associated with IFTT surgery.
Main Methods:
- Retrospective European multicentric study (2006-2021).
- Inclusion of pediatric patients (≤18 years) diagnosed with IFTT.
- Descriptive analysis of case series data.
Main Results:
- Sixty-four girls (6-17 years) underwent surgery for IFTT.
- Tubal detorsion was performed in 87% of cases; salpingectomy in 44%.
- Tubal cysts and hydrosalpinx (HSX) were common causes; 15% had HSX. 12% required re-intervention for persistent pain.
Conclusions:
- IFTT without malformation has a favorable prognosis with detorsion.
- Tubal malformation or HSX may require additional procedures like ablation or neosalpingostomy to prevent recurrence.
- Appropriate surgical management is key to reducing complications and improving outcomes in pediatric IFTT.
Purpose:
The aim of the study was to describe the current surgical practices in managing isolated fallopian tubal torsion (IFTT) in children, identify the most appropriate surgical procedure, and assess the associated postoperative complications and recurrence rates.
Methods:
A retrospective European multicentric study was conducted, included all patients aged 18 years or younger who underwent IFTT between 2006 and 2021. A detailed descriptive analysis based on a case series presentation was conducted.
Results:
Sixty-four girls aged 6-17 years who underwent surgery for IFTT across eight European paediatric centers were included. Surgical procedures included: tubal detorsion (87%), partial salpingectomy (6%), total salpingectomy (44%), and salpingotomy (5%). Histopathological analysis identified tubal cysts and hydrosalpinx (HSX) as common causes of torsion. HSX was found in 15% of cases, and neosalpingostomy was performed in two patients with recurrent abdominal pain after initial surgery. Overall, 12% of patients required more than one surgical intervention due to persistent abdominal pain.
Conclusion:
IFTT alone, in the absence of tubal malformation, provides a favourable prognosis with a straightforward detorsion procedure. If a tubal malformation is detected during the surgery, an ablation of malformation is advised in order to avoid recurrences. In the event of HSX being present, the option of a neosalpingostomy can be proposed. Our results emphasize the importance of timely diagnosis and appropriate surgical management to reduce complications and improve outcomes in paediatric IFTT.
