A New Technique of Oophoropexy: Folding and Fixating of Utero-Ovarian Ligament to Round Ligament in a Patient with Reccurrent Ovarian Torsion.

Mehmet Obut,Uğur Değer

doi:10.1155/2019/7647091

Abstract

Introduction Most cases of ovarian torsion occur in the reproductive age and many are related to ovarian and paraovarian masses. If it occurs without any subtle anatomic etiology or ovarian and paraovarian masses, recurrence of ovarian torsion is more likely. Recurrent left ovarian torsion is much less common than recurrent right ovarian torsion. The authors describe a rare case with their new ovarian fixation technique. Case and Method A 21-year-old female patient with polycystic ovarian syndrome had a 7th recurrence of left ovarian torsion. Although ovarian fixation was performed in addition to detorsion at the 5th and the 6th laparoscopic surgeries, it had failed. Due to recurrence ovarian torsion after ovarian fixation, the authors performed a different technique:folding the utero-ovarian ligament which folded on itself. The distal part of the utero-ovarian ligament with the ovary was both fixed to the proximal part of the round ligament which was adjacent to the uterus. Conclusion Although a wide range of oophoropexy methods have been described in the literature, the best method remains a matter for debate. This technique can be performed even when the ovarian tissue is necrotic. Because of this, we think that this technique is useful and effective technique.

Highlights

Most cases of ovarian torsion occur in the reproductive age and many are related to ovarian and paraovarian masses
We report an extraordinary case who su ered from seven repeated le ovarian torsions and had undergone four laparoscopic detorsions and three laparoscopic detorsions with oophoropexy procedures in the last year
7: Position of uterus tubes and ovaries a er xation procedure completed. This is the rst case in the English literature with seven di erent reoccurrences of the le ovarian torsion following laparoscopic detorsion in the past year, with the last three procedures, including oophoropeies

Summary

Introduction

Ovarian torsion is a gynecological emergency since the blood circulation to the ovary is disrupted due to the rotation of the ovary alone or along with the uterine tubes around its ligaments and may progress to ovarian necrosis if not corrected promptly. More than 80% of patients with ovarian torsion had ovarian masses of 5 cm or larger, indicating that the primary risk in ovarian torsion is an ovarian mass, contrarily premenarchal girl with ovarian torsion are more commonly found with a normal ovary [3,4,5] Both the diagnosis and treatment of ovarian torsion is carried out via laparoscopy in most cases because it is a minimally invasive technique [6]. Oophoropexy is a surgical procedure carried out to protect the fertility of the patient and to reduce the risk of future ovarian torsion, but the debate is still on-going regarding the best correction method [6, 10]. To our knowledge and based on literature review, this is the rst case with these many recurrences of le ovarian torsion

Case and Method

Findings

Discussion