Laparoscopic management of ovarian remnant.

ABSTRACT

OBJECTIVE: To report outcomes of laparoscopic management of patients with ovarian remnant (OR). DESIGN: Retrospective chart review. SETTING: Referral practice and tertiary medical center. PATIENT(S) Sixty-four patients with confirmed OR who underwent laparoscopic treatment between July 1989 and September 2003. INTERVENTION(S) Laparoscopic excision of OR. MAIN OUTCOME MEASURE(S) Technical feasibility and recurrence. RESULT(S) Sixty-nine laparoscopies were performed to remove ovarian remnants, with five patients requiring two laparoscopies. Two cases were converted to laparotomy and one to mini-laparotomy for bowel resection. In 64% (41 out of 64), pelvic mass was diagnosed by imaging (35 by ultrasound, 5 by computerized tomography [CT], and 1 by both). The majority of ovarian remnants were found attached to one or more of the following ureter, bowel, pelvic sidewall, bladder, rectum, and uterosacral ligament. Intraoperative complications occurred in four cases three enterotomy and repair; one cystotomy and repair. Twelve minor postoperative complications occurred including urinary tract infection, hematuria, umbilical incision infection, and transient tachycardia. Three major postoperative complications occurred one umbilical omental hernia, one wound abscess requiring operation, and one vesicovaginal fistula. Adhesions were present in all cases, endometriosis in 55% (35 out of 64), and fibrosis in 30% (19 out of 64). CONCLUSION(S) In experienced hands, laparoscopic treatment of OR results in acceptable outcomes with its associated advantages over laparotomy.