What is the recommended treatment for ovarian torsion?

From the Guidelines

The recommended treatment for ovarian torsion is immediate surgical intervention, typically through laparoscopy or laparotomy, to untwist the affected ovary and restore blood flow. This approach is supported by the most recent evidence, which emphasizes the importance of prompt treatment to prevent permanent ovarian damage or necrosis 1. The goal of surgery is to evaluate the viability of the ovary after detorsion and preserve the tissue if possible.

Key Considerations

• If the ovary appears viable after detorsion, it may be fixed to nearby structures (oophoropexy) to prevent recurrence.
• If the ovary is necrotic, partial or complete removal (oophorectomy) may be necessary.
• Pain management before and after surgery typically includes NSAIDs and opioids for severe pain.
• The window for ovarian salvage is approximately 8-10 hours after symptom onset, though successful recovery has been reported even after longer periods 1.

Diagnostic Approach

• Transvaginal ultrasound (TVUS) is a useful imaging modality for initial assessment, with a sensitivity of 83.3% for ovarian torsion 1.
• Signs of ovarian torsion on US include ovarian tissue edema, absence of intraovarian vascularity, and absence of arterial flow 1.

Treatment Outcomes

• Prompt treatment is crucial to prevent permanent ovarian damage, which can affect fertility, especially if both ovaries are involved or if the patient has had previous ovarian surgery 1.
• Delayed treatment significantly increases the risk of permanent ovarian damage, emphasizing the need for immediate surgical intervention 1.

From the Research

Treatment for Ovarian Torsion

• The recommended treatment for ovarian torsion is surgery or detorsion, which is the mainstay of diagnosis and treatment 2.
• Laparoscopy is a recommended procedure for ovarian conservation, as it has a shorter hospital stay, fewer postoperative complications, and allows for ovarian preservation 3.
• In some cases, laparoscopic oophoropexy may be a reasonable alternative to prevent recurrent torsion, especially in young patients 4.
• The efficiency of oophoropexy in preventing recurrent ovarian torsion is controversial, and most patients with early diagnosis of ovarian torsion may have a better prognosis with conservative surgery 5.
• Early diagnosis is crucial to preserve ovarian function, and the integration of clinical presentation and imaging and laboratory examinations is necessary to increase the accuracy of diagnosis 5.

Surgical Procedures

• Laparoscopy and laparotomy are two common surgical procedures used to treat ovarian torsion, with laparoscopy being preferred for its minimally invasive approach and shorter recovery time 3.
• The choice of operating method depends on various factors, including the size of the ovarian mass, with smaller masses being more suitable for laparoscopy 3.
• Discriminant analysis has shown that mass size is a determining factor for the choice of operating method 3.

Diagnostic Criteria

• Clinical presentations of ovarian torsion include abdominal pain, nausea, and vomiting, which are often non-specific and can lead to delayed diagnosis 5, 3.
• Imaging examinations, such as computed tomography and Doppler sonography, can provide valuable information for diagnosis, with abnormal ovarian flow being a good predictor of ovarian torsion 5, 6.
• The lack of ovarian blood flow on Doppler sonography is a significant predictor of ovarian torsion, with a sensitivity of 43.8% and specificity of 91.7% 6.