Contemporary Trends in Laparoscopy and Ovarian Sparing Surgery for Ovarian Torsion in the Pediatric Population

Infographic · Apr 2024 · 1 min read

In brief

Nationwide study comparing ovarian-sparing surgery versus total oophorectomy in pediatric ovarian torsion cases demonstrates equivalent outcomes with fertility preservation benefits. Analysis of 3,161 patients shows laparoscopy more commonly used with ovarian-sparing approaches, supporting current guidelines favoring ovarian preservation.

Ovarian sparing surgery (OSS) shows equivalent outcomes to total oophorectomy with added fertility preservation benefits in pediatric torsion.
Laparoscopy was used in only 48% of cases despite being more commonly paired with ovarian-sparing approaches (60% vs 40%).
Recurrent torsion rates were extremely low (<1%) regardless of whether OSS or total oophorectomy was performed.
Open approaches were still more common than laparoscopy (52% vs 48%), suggesting opportunity to increase minimally invasive utilization.
Current guidelines favoring OSS as primary treatment for pediatric ovarian torsion are supported by this large database analysis.

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New Infographic by Kim Priban

Contemporary Trends in Laparoscopy and Ovarian Sparing Surgery for Ovarian Torsion in the Pediatric Population

Authors: Carlos Theodore Huerta, Cindy Rodriguez, Joshua Parreco, Chad M. Thorson, Juan E. Sola,Eduardo A. Perez

Full Article: https://doi.org/10.1016/j.jpedsurg.2023.10.042

Abstract

Purpose

Although total oophorectomy (TO) was historically performed in cases of nonviable-appearing ovaries, considerable evidence has demonstrated equivalent outcomes after ovarian sparing surgery (OSS) as well as long-term fertility preservation benefits. This study sought to compare outcomes of OSS and TO for patients with ovarian torsion.

Methods

Females <21 years old admitted for ovarian torsion were identified from the Nationwide Readmissions Database (2016–2018) and stratified by OSS or TO. Propensity score-matched analysis (PSMA) utilizing >50 covariates (demographics, medical comorbidities, ovarian diagnoses, etc.) was constructed between those receiving TO and OSS.

Results

There were 3,161 females (median 15 [12–18] years) with ovarian torsion, and concomitant pathologies included cysts (42%), benign masses (25%), and malignant masses (<1%). Open approaches were more common (52% vs. 48% laparoscopic), and ovarian resection (OSS or TO) was performed in 87% (39% OSS and 48% TO). OSS was more commonly performed with laparoscopic detorsions (60% vs. 40% TO), while TO was more frequent in open operations (59% vs. 41% TO; both p < 0.001). No differences in overall readmissions (7% OSS vs. 8% TO) or readmissions for recurrent torsion (<1% overall) and ovarian masses (<1%) were observed (both groups <1%; p = 0.612). After PSMA, laparoscopy was still utilized less frequently with TO (39% vs. 53%; p < 0.001) despite similar rates of malignant masses.

Conclusions

Overall, these data offer additional support for the current practice guidelines that give preference to OSS as the primary method of treatment for pediatric ovarian torsion in the majority of cases.

Level of Evidence

III.

Type of Study

Retrospective Comparative Study.

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