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Outcome of conservative laparoscopic surgery for adnexal torsion through one‐stage or two‐stage operation
Author(s) -
Fujishita Akira,
Araki Hiroyuki,
Yoshida Shiko,
Hamaguchi Daisuke,
Nakayama Daisuke,
Tsuda Nobuo,
Khan Khaleque Newaz
Publication year - 2015
Publication title -
journal of obstetrics and gynaecology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.597
H-Index - 50
eISSN - 1447-0756
pISSN - 1341-8076
DOI - 10.1111/jog.12534
Subject(s) - medicine , surgery , laparoscopy , cystectomy , ovarian torsion , adnexal diseases , laparoscopic surgery , adhesion , conservative treatment , stage (stratigraphy) , paleontology , chemistry , bladder cancer , organic chemistry , cancer , biology
Aim We investigated the outcome on ovarian appearance and occurrence of adhesion after conservative laparoscopic surgery for adnexal torsion during reproductive age. Material and Methods From A pril 2009 to S eptember 2012, we treated patients with clinically suspected adnexal torsion who desired future pregnancy. We performed conservative surgery, such as cystectomy or detorsion at one‐stage operation, but switched to salpingo‐oophorectomy in complicated cases. We evaluated adnexal condition and pattern of adhesion by careful assessment with two‐stage laparoscopy or second‐look laparoscopy after first surgery. Results Mean age of patients was 25 ± 8 years. Among 37 patients with suspected adnexal torsion, 18 (49%) had adnexal torsion at first surgery. Conservative treatment was carried out in 14 of 18 cases. We obtained informed consent for second‐look laparoscopy or two‐stage operation in six of these 14 cases. Among these six patients, two cases were treated with only detorsion by one‐stage operation and cystectomy was performed in the other four cases at first operation. At subsequent surgery, the ovary appeared normal in six cases with occurrence of mild to moderate adhesion around the adnexal lesion. Of note, two cases with para‐ovarian cyst had torsion that showed complete tubal occlusions and associated severe adhesions. No major complications (peritonitis, thrombotic emboli) were observed after conservative laparoscopic surgery. Conclusion Conservative laparoscopic surgery is a safe procedure to preserve ovarian function in women with adnexal torsion. Careful attention and measures should be considered during follow‐up management with the fact in mind that adhesion is a common occurrence and even tubal occlusion may occur in some cases.