Ovarian function in pediatric and adolescent ovarian torsion: effect of immediate cystectomy

Abstract

Objectives Adnexal torsion is rare in children and adolescents. Guidelines emphasize early diagnosis and detorsion as optimal management. Concurrent cystectomy has been suggested to be associated with possible increased ovarian dysfunction. Our aim is to determine if cystectomy at the time of detorsion is associated with higher rates of impaired ovarian function compared to detorsion alone. Methods With REB approval, a retrospective cohort study of confirmed adnexal torsion in patients ≤ 18 years from 1/1/2004 to 31/12/2018, in a tertiary pediatric centre, with ovarian sparing surgery was undertaken. Patients without postoperative imaging were excluded. Data was collected on demographics, procedure, intraoperative findings, and postoperative ultrasound. Ovarian function was defined as the presence of any of the following: follicles present, normal blood flow or radiologist impression of normal ovary. Detorsion with surgery to ovary was compared to detorsion with no other surgery using independent samples t-test, Chi-square or Fisher's Exact test; significance level 0.05. Results 119 patients met inclusion criteria. 67 (56%) underwent detorsion with surgery to the ovary and 52 patients (44%) underwent detorsion alone. There was no difference regarding post-operative viability on ultrasound. 93% who had surgery to the ovary, and 89% who had detorsion alone were considered viable, p=.446. Detorsion with ovarian surgery had a lower torsion recurrence rate (3%) versus detorsion alone (with or without associated cyst) 17% and 20%, p=0.021. Conclusions Our study demonstrates that further surgery at ovarian detorsion does not impact ovarian function, when compared to detorsion alone and may protect against ovarian torsion recurrence.