92: Comparison of surgical management of adnexal masses and/or torsion in pediatric and adolescent population between gynecologists and other physician specialties

Abstract

Compare surgical approach and procedure type between gynecologist and other surgeon types for management of an adnexal mass and/or torsion in female children and adolescents who are less than 20 years old. Female adolescents and children <20 years old who underwent surgery for management of an adnexal mass and/or torsion between January 2013 and August 2018 were identified in the medical record for inclusion in the study. Neonates (age less than 1 year) were excluded. Chart review was performed to ascertain baseline patient characteristics. Operative records, imaging studies and postoperative visit notes were reviewed to obtain the primary outcome variables: procedure approach (minimally invasive or laparotomy) and procedure type (such as oophorectomy, detorsion). Categorical variables were analyzed with Chi-square or Fisher's exact tests where appropriate based on sample size. Continuous variables were analyzed using paired t-tests. Preliminary analysis of 81 patients who met inclusion criteria was performed. The majority of patients were white (80.3%) and presented with pelvic pain as the initial symptom (92.6%). Imaging characteristics showed mostly simple cysts (42.0%) and suspected torsion (24.7%). The pediatric surgery team made the initial treatment recommendation 66.7% of the time. Although all of the patients included in the study eventually underwent surgery, surgical management was recommended as first-line treatment in 74.1% of patients. Only gynecologists and pediatric surgeons performed the surgeries. Preoperative diagnosis was adnexal torsion in 48.3% of patients seen by pediatric surgeons, as opposed to 13% in the gynecologist group. Pediatric surgeons performed adnexal detorsion in 37.9% of patients compared to 8.7% by gynecologists (p-value 0.009). Although gynecologists were more likely to perform salpingectomy than pediatric surgeons (34.8% and 10.3%, respectively, p-value 0.009), they were more likely to indicate paratubal cyst as the preoperative diagnosis (34.8% compared to 8.6%). No differences in surgical approach, estimated blood loss, and operative time were noted. No intra- or postoperative complications occurred in either group. Surgical management of adnexal masses and/or torsion in female patients between 1 and 20 years old was exclusively performed by gynecologists and pediatric surgeons at our institution. Pediatric surgeons were more likely to perform surgery for adnexal torsion, whereas gynecologists were more likely to indicate paratubal cyst as a preoperative diagnosis. Pediatric surgeons were more likely to perform adnexal detorsion and less likely to perform salpingectomy at time of surgery. Otherwise, no differences were noted in surgical approach (minimally invasive and laparotomy), estimated blood loss, and operative time between the two groups.