Postoperative Ovarian Morphology on Ultrasound after Ovarian Torsion-Effect of Immediate Surgery: A Retrospective Cohort Study.

ABSTRACT

STUDY OBJECTIVE: Our objective was to determine if ovarian surgery at the time of ovarian detorsion is associated with impaired short-term ovarian function as indicated by ovarian morphology on ultrasound when compared with detorsion alone. DESIGN: Retrospective cohort study SETTING: The Hospital for Sick Children, Toronto PARTICIPANTS: Patients ≤ 18 years old with confirmed ovarian torsion from January 1, 2004, to December 31, 2018, with ovarian-sparing surgery. MAIN OUTCOME MEASURES: Data were collected on demographics, procedure, intraoperative findings, and postoperative ultrasound. To determine ovarian function, we compared the morphology on the postoperative ultrasound between those with surgery to the ovary and those without surgery to the ovary at the time of detorsion. We also compared the ovarian volume of affected and contralateral ovaries after detorsion and surgery to the affected ovary. RESULTS: One hundred and nineteen patients met the inclusion criteria, of whom 67 (56%) had detorsion with surgery to the ovary and 52 (44%) had detorsion alone. There was no statistically significant difference in appearance on the postoperative ultrasound between these groups (P =.446). There was also no statistically significant difference on the postoperative ultrasound of affected and contralateral ovarian volumes after detorsion and surgery to the affected ovary (P = .69). Patients who underwent surgery to the ovary experienced a lower rate of recurrence; however, this did not reach statistical significance, with a P value of 0.080. CONCLUSION: Our study demonstrates that surgery, eg cystectomy to the ovary at the time of ovarian detorsion, does not appear to impact ovarian function when compared with detorsion alone, as indicated on postoperative imaging. There was also no difference in volume of the affected and contralateral ovaries in those cases that underwent surgery at the time of initial detorsion. This evidence would support that immediate cystectomy at the time of initial ovarian detorsion is not associated with impaired ovarian function, thus avoiding the need for an interval cystectomy.