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Long-term follow-up of the twisted ischemic adnexa managed by detorsion
G Oelsner1, D Bider, M Goldenberg
1Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Israel.
Objective:
To examine our assumption that although the twisted adnexa appears ischemic-hemorrhagic, it can safely be revived by detorsion with preservation of ovarian function.
Design:
Patients' records were obtained from a computerized database and reviewed. The preoperative diagnosis of adnexal torsion was based upon patients' symptoms, clinical examination, laboratory investigations, and ultrasound scanning.
Setting:
Gynecology department at a large teaching hospital receiving primary referrals of public sector patients.
Patients:
In 40 patients who presented with signs and symptoms suggestive of ovarian torsion, "black-bluish" ischemic adnexa were encountered at surgery.
Interventions:
All patients were managed by unwinding of the adnexa: laparotomy in 26 cases and operative laparoscopy in 14. In 13 patients detorsion only was performed, in 15 detorsion and cystectomy were carried out, and in 12 patients detorsion was done and ovarian cysts aspirated.
Main Outcome Measures:
Postoperative course, mean hospitalization period, follow-up pelvic examination, ovarian folliculogenesis on ultrasound examination, and oocyte retrieval and fertilization.
Results:
The size of the twisted ovary ranged from 4 to 20 cm (mean, 9.5 cm). The postoperative course was uneventful, except for transient temperature elevation in five patients. The mean hospitalization period was 6.5 days (range 5 to 10 days) after laparotomy and 1.8 days (range 1 to 3 days) after laparoscopy. Three patients were lost to follow-up. In 37 patients, pelvic examination was normal. A normal sized ovary, with follicular development, was demonstrated sonographically in 35 of 37 patients. In 6 of 7 patients, macroscopically normal adnexa were visualized at subsequent laparotomy or laparoscopy. In two patients undergoing IVF, oocytes were retrieved and fertilized from the detorted ovary. The patency of the fallopian tube was demonstrated in four cases.
Conclusions:
This new "adnexal-sparing" approach should be applied instead of the traditional salpingo-oophorectomy in young women with twisted ischemic adnexa.