Conservative laparoscopic surgery of adnex torsion for fertility preservation

Abstract

ObjectivesTo evaluate the safety and efficacy of conservative laparoscopic surgery for adnexal torsion and the feasibility of secondary operation. MethodsThis is a retrospective study that consists of 17 patients with clinically diagnosed adnexal torsion who have a desire for pregnancy in the future. We performed conservative laparoscopic adnexal detorsion operations from January 2014 to June 2016 in Sir Run Run Shaw Hospital. The collected data, including age, onset time, maximum diameter of adnexal lesion, local blood flow signal, torsion degree, and recovery of local blood supply after detorsions, were analyzed. The blood flow of the lesion side, the antral follicles development, the basal endocrine hormone levels and the menstrual cycle were examined one-month and three-month post operation. Future fertility was investigated postoperatively. ResultsAll cases had no obvious clinical postoperative complications. There were no significant changes on menstrual cycle and ovarian function during the follow-up period. ConclusionsAdnexal torsion in young patients should be carefully treated and fertility reservation should be thoroughly considered. The decision to remove adnexa needs careful consideration. Conservative laparoscopic surgery is safe and does not increase the occurrence of serious complications. There is a higher possibility of a long delay between surgery and onset necrosis, but this is not always the case. Even if there is adnex thromboembolic infarction it does not result in serious complications such as pulmonary infarction. Conservative laparoscopic surgery can be performed first unless the clinician is certain it is already necrotic. We should do our best to reserve patients’ fertility as much as possible. If necessary, a secondary surgery can be performed.