What are the current surgical management guidelines for ovarian torsion?

From the Guidelines

The current surgical management of ovarian torsion, particularly in the context of adnexal masses during pregnancy, involves prompt surgical intervention, preferably via laparoscopic detorsion, to minimize ischemic damage and preserve ovarian function. Upon diagnosis of ovarian torsion, especially in symptomatic cases, surgery is the recommended approach, as indicated in the management guidelines for adnexal masses during pregnancy 1. The procedure involves careful evaluation of the adnexa, followed by untwisting of the ovary and fallopian tube. Key considerations in the surgical management include:

• Prompt intervention to reduce ischemic time and potential for complications
• Laparoscopic approach for its minimally invasive benefits
• Preservation of ovarian tissue whenever possible, especially in reproductive-aged women
• Consideration of cystectomy or mass removal if a cyst or mass is present, while preserving normal ovarian tissue
• Potential for oophoropexy in specific cases, though its use remains controversial The approach to ovarian torsion, as outlined, prioritizes minimizing morbidity, reducing mortality risk, and preserving quality of life, particularly fertility and hormonal balance in women of reproductive age, as supported by recent guidelines and studies 1.

From the Research

Surgical Management Guidelines for Ovarian Torsion

The current surgical management guidelines for ovarian torsion include:

• Laparoscopic detorsion of the torquated ovaries, as demonstrated in a case study 2
• Cystectomy on an ischemic ovary 2
• Oophoropexy to the pelvic side wall and utero-ovarian ligament to prevent recurrence 2, 3
• Preservation of the ovary, as recommended by leading guidelines 2

Key Considerations

• Early diagnosis is crucial to preserve ovarian function and prevent severe morbidity 4, 5
• Clinical presentation, imaging, and laboratory examinations should be integrated to increase the accuracy of diagnosis 5
• Computed tomography findings, plasma d-dimer level, and the time from pain onset play a critical role in distinguishing ovarian necrosis 5
• The efficiency of oophoropexy on preventing recurrent ovarian torsion is controversial 5

Surgical Techniques

• Laparoscopic management is preferred over laparotomy due to lower febrile morbidity and shorter hospital stay 6
• Detorsion without removal of the adnexa or the ovary can be performed by laparoscopy or laparotomy 6
• Oophoropexy can be performed laparoscopically to prevent recurrent torsion 3