ASRM 2019 — Ovarian torsion: conservative surgery does not increase complications


  • Daniel M. Keller, Ph.D
  • Conference Reports
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Takeaway

  • Surgical emergency of ovarian torsion traditionally treated with oophorectomy.
  • Accumulating evidence that ovary-preserving surgery does not lead to an increase in perioperative complications, and thus should be considered, especially for younger women.
  • 90% of ovaries appearing nonviable intraoperatively (blue/black) can regain function and normal appearance.

Why this matters

  • Concern about venous thromboembolism, pulmonary embolism, peritonitis, or infection prompts oophorectomy.
  • Accumulating evidence that ovary-preserving surgery does not lead to increased complications, and is therefore a reasonable option.

Study design

  • Retrospective populational observational study.
    • National Inpatient Sample 2001-2015, representing >90% of population weighted.
    • Women
  • Conservative surgery (detorsion possibly with cystectomy, cyst drainage, or oophoropexy) vs oophorectomy.
  • No ovarian or tubal malignancy.
  • No outside study funding.

Key results 

  • Conservative surgery n=20,643 (23%); oophorectomy n=69,157 (77%).
  • Conservative surgery.
    • Detorsion only, 11.4%; cystectomy, 77.9%; cyst drainage, 18.6%; oophoropexy, 0.5%.
    • Surgical approach: laparoscopy, 51.2%; laparotomy, 41.7%; unknown, 8.1%.
  • Oophorectomy: laparoscopy, 32.6%; laparotomy, 67.4%.
  • Perioperative complications (oophorectomy vs conservative surgery).
    • Any: 11.9% vs 8.3% (OR, 0.67; 95% CI, 0.57-0.78; P<.001>
    • Venous thromboembolism: 0.3% vs 0.2% (P=.568), and
    • Sepsis: 0.3% vs 0.3% (P=.865).
  • 75% of young women still undergo oophorectomy; 60% still undergo laparotomy.

Limitations

  • Potential misclassification.
  • Missing variables: intraoperative findings, time to surgery, type of surgeon, fertility desires.
  • Timing of complications.
  • No follow-up postdischarge.