Laparoscopy versus laparotomy for detorsion and sparing of twisted XXXX adnexa.

@entity1 @entity43 @entity1031 @entity63
BACKGROUND: Torsion of the ovary is an urgent event for fertile @entity1 . Until recent years, the common treatment for twisted @entity63 ovaries was salpingo-oophorectomy. We have demonstrated in the past that the ovary can be salvaged provided detorsion is performed. We studied the outcome of @entity1 undergoing minimal surgery for @entity63 ovaries versus the extended procedure including cystectomy in respect of ovarian function and fertility performance. METHODS: We retrospectively studied 102 @entity1 who underwent surgery for torsion of the ovary in which the macroscopic appearance of black-bluish @entity63 adnexa was encountered during surgery. @entity43 was performed by laparoscopy in 67 @entity1 and by laparotomy in 35 @entity1 . @entity1 ' files were reviewed for immediate and late outcomes. @entity1 were examined postoperatively with vaginal ultrasound for ovarian follicular function. Data concerning @entity1 ' further surgeries or in vitro fertilization were retrieved from the charts as well. RESULTS: Febrile morbidity was approximately 15% and 29% in the laparoscopy and laparotomy groups, respectively. Hospital stay was 2.1 +/- 1.2 and 7.4 +/- 1.5 days in the laparoscopy and laparotomy groups, respectively (P<0.001). Ultrasound follow-up was available in 60 of 67 @entity1 who underwent laparoscopy and in 32 of 35 @entity1 treated by laparotomy. Normal-sized ovaries with follicular development were encountered in the detorsed side in 93% and 91%, respectively. Normal macroscopic appearance of the adnexa at subsequent surgeries was reported in 9 of 9 @entity1 in the laparoscopy group and in 4 of 5 @entity1 in the laparotomy group. Four @entity1 from the laparoscopy group and 2 from the laparotomy group underwent subsequent in vitro fertilization. In all 6 @entity1 , oocytes retrieved from the previously detorsed ovary were fertilized. In both groups, none of the @entity1 developed clinical signs of pelvic or systemic @entity1031 . CONCLUSIONS: Torsion of the @entity63 adnexa should be treated laparoscopically by detorsion and adnexal sparing.
