Management of adnexal torsion by laparoscopic approach

Abstract

The study aimed to evaluate the effectiveness and safety of laparoscopic management of adnexal torsion. Early minimal invasive surgical management of adnexal torsion with the main emphasis on an organ-preserving procedure can safely be recommended. Although the incidence of adnexal torsions has increased, the morbidity rate has declined due to safer diagnostics and operative strategies. This is a retrospective case-control study (Canadian Task Force classification II-3) of 33 cases of adnexal torsion over an 11-year period (December 1999-September 2010) in a gynecologic endoscopy unit of a university hospital. Interventions include early diagnostic laparoscopy and utmost protection of the surrounding tissue. Thirty-three cases of laparoscopically managed adnexal torsions were analyzed. Fifty-two percent had conservative organ-sparing procedures, while 48 % underwent resection of ovary, tube, or both. The mean operating time was 69.2 min. There were no complications or conversions to laparotomy. The most common predisposing factor was an adnexal mass with symptoms of pain. Torsion on the right tube is more common than on the left. Laparoscopic surgery is an effective, safe, and feasible method in the diagnosis and treatment of adnexal torsion.

Intraoperative Utilization of Indocyanine Green (ICG) Dye for the Assessment of Ovarian Perfusion—Case Report and Review of the Literature

“…Ultrasound findings were suggestive of ovarian torsion (ovarian stromal edema, presence of whirlpool sign) based on the known signs (see above, [21,48]). The right-sided bias of ovarian torsion [7,8] verified itself in this case. In the presented case, the application of ICG with consecutive visualization of restored ovarian perfusion prevented oophorectomy without signs of complications.…”

“…Several case reports of ovarian torsion in pregnant patients and in the pediatric population [ 3 , 4 , 5 , 6 ] have been published. Furthermore, several studies reveal that right-sided torsions are more common [ 7 , 8 ]. Although some case reports describe conservative treatments [ 9 ], the most common treatment is surgical.…”

Appearances Are Deceptive: Two Case Reports in Teenagers on the Conservative Laparoscopic Surgery for Adnexal Torsion with Apparent Infarction

“…Another retrospective case-control study ( n = 33) has compared laparoscopic surgical versus conservative organ-sparing management [ 17 ]. In this study, the mean age was 34.9 years (range 14-68 years) [ 17 ]. Out of 33, 17 cases had “conservative” management of which only two had only detorsion alone.…”

“…The first patient has normally delivered her baby, and the other one is in her seventh month of pregnancy [ 16 ]. Another retrospective case-control study ( n = 33) has compared laparoscopic surgical versus conservative organ-sparing management [ 17 ]. In this study, the mean age was 34.9 years (range 14-68 years) [ 17 ].…”

A clinicopathological study of women with adnexal masses presenting with acute symptoms

“…The intra-operative diagnosis of adnexal necrosis upon failure of reperfusion correlates well with the pathological diagnosis similar to other studies. [ 7 8 ] Current recommendation is to perform conservative surgery for ovarian torsion even if the reperfusion is only partial after detorsion intra-operatively. [ 1 ]…”