Clinical factors and surgical decision-making when managing premenopausal women with adnexal torsion

Abstract

PurposeThe primary objective of this study is to identify if and which clinical factors may in uence surgical decision-making when managing premenopausal women who present emergently with adnexal torsion (AT). MethodsThis retrospective cohort study was conducted at a single tertiary hospital. Medical records for all admissions for AT between 1 January 2010 and 30 June 2020 were reviewed and data regarding patient demographics, history of torsion, and the index admission were collected. Conservative surgery was de ned as detorsion only or detorsion with cyst decompression. Interventional surgery was de ned as ovarian cystectomy, salpingectomy, oophorectomy or salpingo-oopherectomy. Results126 women were included for nal analysis. Of the 109 women diagnosed with AT at emergency surgery, 12 were postmenopausal (all had interventional surgery). In the 97 premenopausal women, 50 (52%) underwent conservative surgery. Pregnant women were more likely to undergo conservative surgery than non-pregnant women (Relative Risk [RR] 0.20, 95% con dence interval [CI] 0.5, 0.75, p=0.001). Women having laparoscopies were also more likely to undergo conservative surgery (RR 0.08, 95% CI 0.01, 0.53, p=0.001) than if they had laparotomies. Although not reaching statistical signi cance, women were more likely to undergo laparotomy if they were febrile or if a senior gynecology consultant was involved in their care. History of torsion, age, parity and ovarian size did not alter the risk of interventional surgery. ConclusionThis study identi ed that premenopausal women who presented emergently with AT were signi cantly more likely to have conservative surgery if they were pregnant or if they underwent laparoscopic surgery.