- 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.
- Retrospective populational observational study.
- National Inpatient Sample 2001-2015, representing >90% of population weighted.
- Conservative surgery (detorsion possibly with cystectomy, cyst drainage, or oophoropexy) vs oophorectomy.
- No ovarian or tubal malignancy.
- No outside study funding.
- 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).
- Potential misclassification.
- Missing variables: intraoperative findings, time to surgery, type of surgeon, fertility desires.
- Timing of complications.
- No follow-up postdischarge.