Ovarian Remnant Syndrome Versus Retroperitonealized Ovary: Preoperative Evaluation and Surgical Management

Abstract

<h3>Study Objective</h3> Our objectives are to compare the definitions of ovarian remnant syndrome and retroperitonealized ovary, present a patient with each condition, describe the preoperative evaluation, and demonstrate the surgical management. <h3>Design</h3> Perioperative evaluation and laparoscopic excision of ovarian remnant syndrome and retroperitonealized ovary. <h3>Setting</h3> Tertiary care center. <h3>Patients or Participants</h3> Reproductive-aged women presenting with pelvic pain and a history of prior pelvic surgery subsequently diagnosed with ovarian remnant syndrome or retroperitonealized ovary. <h3>Interventions</h3> Minimally-invasive retroperitoneal dissection and excision of ovarian remnant or retroperitonealized ovary. <h3>Measurements and Main Results</h3> Ovarian remnant syndrome is the presence of ovarian tissue following an oophorectomy, and retroperitonealized ovary is the presence of ovarian tissue in the retroperitoneum. Patients with a history of pelvic surgery, particularly with extensive retroperitoneal dissection, are at risk for these conditions. Retroperitonealized ovary occurs most frequently following ovarian cystectomy, while ovarian remnant syndrome occurs after oophorectomy. Importantly, ovarian remnant syndrome can usually be anticipated during preoperative evaluation, while retroperitonealized ovary is encountered during the surgery. Patients typically present with chronic pelvic pain. The preoperative workup for patients with suspected retroperitonealized ovary or ovarian remnant syndrome includes a detailed patient history, thorough physical exam, and transvaginal ultrasound evaluation. A follicle-stimulating hormone and estradiol level can evaluate for ovarian function, while a clomiphene provocation test can be used if an ovarian mass is not initially visualized on imaging. Surgical excision is the recommended management option for both conditions. It involves dissection and removal of the ovary from the surrounding structures. In patients with endometriosis, the isolation and removal of the ovarian tissue is typically complicated by dense adhesions to the pelvic sidewall, ureter, and bowel. Complete surgical resection of the ovarian tissue is imperative, as patients are at risk for endometriosis and ovarian cancer. <h3>Conclusion</h3> Both ovarian remnant syndrome and retroperitonealized ovary are potential sequelae of prior pelvic surgery and require surgical resection.