Postoperative Outcomes of Ovarian Preserving Surgery in Premenopausal Women With Adnexal Torsion

Abstract

ABSTRACT Adnexal torsion, a state of twisted ovaries and adnexa in the infundibulopelvic and tuboovarian ligaments, can occur in benign masses, malignant neoplasms, and normal ovaries. Definitive diagnosis of this condition is surgical, with an incidence rate of 2%–15% in women undergoing surgery for an adnexal mass. This incidence rate is possibly low in its estimation, due to lack of diagnosis sans surgical observation of the condition. This state occurs most frequently in women of reproductive age, although it can occur at any age. A decrease in ovarian blood supply during adnexal torsion may lead to ovarian ischemia, for which a lack of immediate treatment results in reduced ovarian function and fertility damage. Patients with suspicion of this condition are treated via emergent surgery. The aim of this study was to analyze anti-Müllerian hormone (AMH) level changes in premenopausal women, along with possible postoperative complications after surgery preserving ovaries in the case of adnexal torsion. The authors’ intent was to prove the value of conservative surgery in preservation of ovarian function, even in cases with intraoperative findings or postsurgery ovarian color changes. The retrospective study was performed at Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea, and included women surgically diagnosed with adnexal torsion between January 2015 and December 2020. Excluded were data for women with no adnexal torsion diagnosis, women who had undergone bilateral ovarian cystectomy, patients lacking AMH data (either prior to or after surgery), and menopausal patients. The study included 71 patients, with 15 in the oophorectomy group and 56 in the ovarian preservation group. Data collected included age, body weight, height, abdominal pain duration, time interval between symptoms and surgery, adnexal mass laterality and size based on the preoperative ultrasounds, and laboratory values (hemoglobin, platelet, white blood cells, and AMH levels). Serum AMH levels were determined both 6 months before surgery and 6–24 months after. Also included were data for postoperative fever/complications and duration of admission. There were 23 patients who had an AMH both before the surgery and postoperatively (19 in the preservation group and 4 in the oophorectomy group). In the ovarian preservation group, 21.0% of patients experienced postoperative fever, with none of the oophorectomy group experiencing similar symptoms. However, all of the fever-stricken patients were discharged with no further complications (ie, pneumonia, surgical site infections, etc). Comparison of both the oophorectomy and ovarian preservation group data showed similar preoperative AMH levels. Postoperatively, serum AMH levels decreased in the oophorectomy group, while slightly increasing in the ovary-preservation group. Despite discoloration and suspected ovarian necrosis, preservation of the ovary preserves ovarian function in reproductive-aged women with adnexal torsion. Only 1 patient undergoing emergent surgery experienced complications. Limitations of the study include its retrospective nature and small sample size when considering patients with emergency surgeries for adnexal torsion diagnoses. In addition, the number of cases with comparable before/after AMH level data available was small. Prospective studies for this area are difficult to perform due to low incidence rates and emergency characteristics. Despite these shortcomings, value can be found in the study data, such as the numerical comparison of ovarian function preservation based on AMH levels before and after surgery. In conclusion, the study found that complications in patients with adnexal torsion were not increased via ovarian-preserving surgery, even with suspected necrosis of the ovary. If preservation of the ovary occurs, the ovarian reserve may not be affected by torsion. For women with cystic masses and adnexal torsion, conservative ovarian surgery (detorsing) can be safely performed to preserve productive potential.