From the Guidelines
The current surgical management of ovarian torsion primarily involves laparoscopic detorsion as the first-line approach, with the goal of preserving ovarian function. Upon diagnosis, prompt surgical intervention should be initiated to minimize ischemic damage. During the procedure, the surgeon should untwist the affected ovary and adnexa, regardless of how necrotic the tissue appears, as the visual assessment of viability is unreliable. After detorsion, the surgeon should observe for reperfusion, which may be confirmed by seeing the tissue change from a blue-black appearance to a more normal color. Oophoropexy (fixation of the ovary) may be considered in certain cases to prevent recurrence, though this is not universally recommended. Cystectomy should be performed if an ovarian cyst is identified as the cause of torsion. Salpingo-oophorectomy (removal of the ovary and fallopian tube) should be reserved only for cases with severe necrosis where tissue is clearly non-viable after detorsion, or in postmenopausal women. In pediatric and reproductive-age patients, ovarian conservation is particularly important, as evidenced by the recommendation to preserve at least part of one ovary and the uterus in young patients with borderline ovarian tumors 1.
Some key points to consider in the surgical management of ovarian torsion include:
- The importance of prompt intervention to minimize ischemic damage
- The use of laparoscopic detorsion as the first-line approach
- The consideration of oophoropexy to prevent recurrence
- The reservation of salpingo-oophorectomy for cases with severe necrosis or in postmenopausal women
- The emphasis on ovarian conservation in pediatric and reproductive-age patients, with studies suggesting that even severely ischemic-appearing ovaries can recover function after detorsion 2.
It is essential to note that the provided evidence primarily focuses on the management of ovarian cancer and borderline ovarian tumors, rather than ovarian torsion specifically. However, the principles of preserving ovarian function and minimizing ischemic damage can still be applied to the management of ovarian torsion. The goal of surgical management should always prioritize preserving ovarian function and minimizing morbidity and mortality, while also considering the individual patient's needs and circumstances.
From the Research
Surgical Management Guidelines for Ovarian Torsion
The current surgical management guidelines for ovarian torsion emphasize the importance of preserving the ovary, particularly in young women, to maintain hormonal function and fertility 3, 4, 5. The following points highlight the key aspects of surgical management:
- Laparoscopic management: Laparoscopic detorsion of the torquated ovaries, cystectomy on an ischemic ovary, and oophoropexy to the pelvic side wall and utero-ovarian ligament are recommended to prevent recurrence 3, 4, 6.
- Oophoropexy: Oophoropexy, or the fixation of the ovary to the pelvic side wall, can help prevent recurrent ovarian torsion, especially in patients with a history of intermittent torsion 6, 5.
- Conservative surgery: Conservative surgery, which aims to preserve the ovary, is recommended for patients with early diagnosis of ovarian torsion, as it can lead to better prognosis and preservation of ovarian function 4, 5.
- Avoiding oophorectomy: Leading guidelines recommend avoiding oophorectomy, or the removal of the ovary, whenever possible, to preserve fertility and hormonal function in young women 3, 4.
- Diagnostic criteria: Accurate diagnosis of ovarian torsion is crucial, and clinical presentation, imaging findings, and laboratory examinations should be integrated to increase diagnostic accuracy 7, 5.
Key Considerations
When managing ovarian torsion, the following considerations are essential:
- Early diagnosis: Early diagnosis is critical to preserve ovarian function and prevent severe morbidity 7, 5.
- Clinical presentation: Abdominal pain, nausea, and vomiting are common clinical presentations of ovarian torsion, and diagnosis should be suspected in patients with these symptoms 7, 5.
- Imaging and laboratory examinations: Imaging findings, such as computed tomography, and laboratory examinations, such as plasma d-dimer level, can help distinguish ovarian necrosis and guide surgical management 5.