Primary
cysts and
tumors of the ovary alongwith torsion are often regarded as an indication for open
oophorectomy because of the fear of leaving an ischemic organ inside and chances of recurrence. We wish to report our experience of both modalities of management where we initially removed adenexal torsion by either laparoscopic
salpingo-oophorectomy or
oophorectomy, but later followed a more conservative approach of adenexal lesion removal with ovarian preservation.
MATERIALS AND METHODS: Retrospective review of clinical records of patients with ovarian pathology who were managed laparoscopically.
RESULTS: 46 cases of pediatric ovarian pathology were managed between March 2006 and March 2013 in two centers by a team of surgeons. The age ranged from 1 days to 18 years (average 14.3 years) and the pathology varied from 30 cases of a simple
ovarian cyst with torsion, 3 cases of
ovarian torsion without any
cyst, 7 cases of a
dermoid cyst with torsion in all, 1 case of secreting ovarian
tumor and 5 cases of a paraovarian
cyst with torsion. All patients had a normal
tumor marker except 1 girl with a functional ovarian
tumor who had elevated LDH and
estrogen levels alongwith suppressed LH and FSH. In the initial period of our study we did 1
salpingo-oophorectomy for a suspected complex lesion and two
oophorectomies for torsion with a simple
cyst. In the later part of our study we performed laparoscopic
cystectomy and ovarian preservation in 40 cases, including 7 cases of
dermoid, where we performed laparoscopic detorsion with
dermoid cystectomy and ovarian preservation in the same sitting. In three cases of chronic torsion who presented to us late, we could not preserve the ovary and had to resort to salpingo-ophorectomy. Histology showed a simple corpus luteal and follicular
ovarian cyst in 31 cases, a paraovarian
cyst in 5 cases with mature
teratoma in 7 cases. Twenty-five patients with ovarian preservation following detorsion were subjected to follow-up ultrasound, who were found to have normal shape, size and blood flow compared to the contra lateral side.
CONCLUSION: We outline our experience from the management of 46 cases of various ovarian pathologies with and without
ischemia and found that
ovarian torsion with a benign pathology and
ischemia is not a
contraindication for ovarian preservation, as pointed out in the current literature.