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Murphy NC, Elborno D, Kives S, Allen LM. Postoperative Ovarian Morphology on Ultrasound after Ovarian Torsion-Effect of Immediate Surgery: A Retrospective Cohort Study. J Pediatr Adolesc Gynecol 2022; 35:353-358. [PMID: 34742939 DOI: 10.1016/j.jpag.2021.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 10/05/2021] [Accepted: 10/28/2021] [Indexed: 11/29/2022]
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.
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Affiliation(s)
- Niamh C Murphy
- The Hospital for Sick Children, Toronto and University of Toronto, Ontario, Canada.
| | - Dana Elborno
- The Hospital for Sick Children, Toronto and University of Toronto, Ontario, Canada
| | - Sari Kives
- The Hospital for Sick Children, Toronto and University of Toronto, Ontario, Canada
| | - Lisa M Allen
- The Hospital for Sick Children, Toronto and University of Toronto, Ontario, Canada
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Yaakov O, Ashwal E, Gemer O, Peled Y, Kapustian V, Namazov A, Eitan R, Krissi H. Acute Adnexal Torsion: Is Immediate Surgical Intervention Associated with a Better Outcome? Gynecol Obstet Invest 2022; 87:100-104. [PMID: 35139515 DOI: 10.1159/000522501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 11/16/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES We aimed to investigate whether surgery for adnexal detorsion within 6 hours from admission to the hospital is associated with less adnexal ischemia. DESIGN Retrospective cohort study Participants/Materials, Setting, Methods: This retrospective study was conducted at two university-affiliated medical centers, assessed women aged 18 to 45 years with adnexal torsion who hospitalized within 12 hours from pain onset and underwent surgery for detorsion within 24 hours. The study group was divided into 2 groups: early, surgical intervention within less than 6 hours and late, surgical intervention between 6 to 24 hours. The primary outcome was the rate of macroscopic appearance of ischemic adnexa. RESULTS Two-hundred and twenty women fulfilled the inclusion criteria. In 101 women, the adnexa with the torsion appeared macroscopically ischemic. There was no difference in ischemic adnexa between the early and late intervention groups. (48% vs. 40%; P=0.269). No significant association was found between the physical examination or ultrasonographic findings and the rate of ischemic adnexa within each group. LIMITATIONS The main limitations of our study are its retrospective nature. Much of the clinical and ultrasonographic data are subjective and operator dependent. The decision to operate may vary from one surgeon to another. CONCLUSION Immediate surgical intervention in patients with adnexal torsion is not associated with a lower rate of adnexal ischemia. These findings suggest that in acute adnexal torsion there wider time window to for a thorough evaluation before surgery.
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Affiliation(s)
- Odelia Yaakov
- Department of Obstetrics and Gynecology, Barzilai University Medical Center, Ashkelon, Israel
| | - Eran Ashwal
- Department of Obstetrics and Gynecology, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Petach Tikva, Israel
| | - Ofer Gemer
- Department of Obstetrics and Gynecology, Barzilai University Medical Center, Ashkelon, Israel
- Faculty of Health Sciences, Ben-Gurion University of Negev, Beer Sheva, Israel
| | - Yoav Peled
- Department of Obstetrics and Gynecology, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Petach Tikva, Israel
| | - Victoria Kapustian
- Department of Obstetrics and Gynecology, Barzilai University Medical Center, Ashkelon, Israel
- Faculty of Health Sciences, Ben-Gurion University of Negev, Beer Sheva, Israel
| | - Ahmet Namazov
- Department of Obstetrics and Gynecology, Barzilai University Medical Center, Ashkelon, Israel
- Faculty of Health Sciences, Ben-Gurion University of Negev, Beer Sheva, Israel
| | - Ram Eitan
- Department of Obstetrics and Gynecology, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Petach Tikva, Israel
| | - Haim Krissi
- Department of Obstetrics and Gynecology, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Petach Tikva, Israel
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Isolated Fallopian Tube Torsion: An Underdiagnosed Entity with Debatable Management. J Minim Invasive Gynecol 2021; 29:158-163. [PMID: 34371191 DOI: 10.1016/j.jmig.2021.07.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/30/2021] [Accepted: 07/30/2021] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE To study features of isolated fallopian tube torsion (IFTT) to promote early diagnosis of this entity and describe options for management. DESIGN Retrospective cohort study from October 2017 through October 2020. SETTING Tertiary care hospital. PATIENTS All patients with surgically confirmed adnexal torsion or IFTT during the study period. INTERVENTIONS All of the patients underwent gynecological examination, imaging, and laparoscopy. MEASUREMENTS AND MAIN RESULTS During this 3-year period, 64 patients underwent laparoscopy owing to confirmed torsion, of which 55 had adnexal torsion, and 9 had IFTT. Patients with IFTT tended to be younger (21.2 years ± 8.2 vs 29.1 years ± 11.9, p = .06) and had more fever on admission (p = .007). On ultrasound examination, isolated hydrosalpinx was demonstrated only in patients with IFTT (p <.001). During surgery, more para-ovarian cysts were observed in patients with IFTT (44.4% vs 10.9%, p = .01), whereas patients with adnexal torsion had more ovarian cysts (52.7% vs 0%, p = .003). The most common procedure was detorsion in both groups. Most patients that underwent detorsion of the tube had a normal ultrasound scan on follow-up examination. CONCLUSION IFTT is probably underdiagnosed. Its clinical presentation is more equivocal than adnexal torsion, and ovaries are usually of normal size on ultrasonography. Hydrosalpinx or para-ovarian cysts should raise suspicion toward IFTT. Detorsion of the tube is probably a valid management option, although further research with long-term follow-up analyzing tubal patency is necessary to define the optimal management for this condition.
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Michelis LD, Politch JA, Kuohung W. Factors Associated with Oophorectomy in Patients with Suspected Ovarian Torsion. J Gynecol Surg 2021. [DOI: 10.1089/gyn.2020.0087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Laura Daniela Michelis
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Joseph A. Politch
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Wendy Kuohung
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, Massachusetts, USA
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Bardin R, Perl N, Mashiach R, Ram E, Orbach-Zinger S, Shmueli A, Wiznitzer A, Hadar E. Prediction of Adnexal Torsion by Ultrasound in Women with Acute Abdominal Pain. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2020; 41:688-694. [PMID: 31703238 DOI: 10.1055/a-1014-2593] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE To investigate the accuracy of ultrasound in the diagnosis of adnexal torsion. MATERIALS AND METHODS Retrospective cohort analysis of 322 women, presenting to a tertiary medical center with acute abdominal pain, who underwent gynecological examination, sonographic evaluation and laparoscopic surgery, between 2010 and 2016. Findings for adnexal torsion were compared among three groups: positive sonographic findings consistent with surgically confirmed adnexal torsion (true positive, n = 228); negative sonographic findings inconsistent with surgically confirmed adnexal torsion (false negative, n = 42); and positive sonographic findings inconsistent with a surgical diagnosis other than adnexal torsion (false positive, n = 52). Outcome measures were sensitivity and positive predictive value of ultrasound, and its specific features, for the diagnosis of adnexal torsion. RESULTS The sensitivity of ultrasound for adnexal torsion diagnosis was 84.4 %, and the positive predictive value was 81.4 %. Edematous ovary and/or tube, as well as positive whirlpool sign had the highest sensitivity and positive predictive value. The false-negative group had the highest frequency of ovarian cysts (p = 0.0086) and the lowest frequency of ovarian edema (p < 0.0001). The false-positive group had the lowest proportion of pregnant women (p = 0.0022). Significantly more women in the true-positive group had a prior event of adnexal torsion (p = 0.026). CONCLUSION Ultrasound examination is highly accurate in the diagnosis of adnexal torsion. Clinicians should be aware of the presence of demographic and clinical characteristics that may positively or negatively affect sonographic diagnostic accuracy.
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Affiliation(s)
- Ron Bardin
- Helen-Schneider-Hospital for Women, Rabin Medical Center, Petah Tikva, Israel
| | - Noga Perl
- Helen-Schneider-Hospital for Women, Rabin Medical Center, Petah Tikva, Israel
| | - Reuven Mashiach
- Helen-Schneider-Hospital for Women, Rabin Medical Center, Petah Tikva, Israel
| | - Eitan Ram
- Helen-Schneider-Hospital for Women, Rabin Medical Center, Petah Tikva, Israel
| | | | - Anat Shmueli
- Helen-Schneider-Hospital for Women, Rabin Medical Center, Petah Tikva, Israel
| | - Arnon Wiznitzer
- Helen-Schneider-Hospital for Women, Rabin Medical Center, Petah Tikva, Israel
| | - Eran Hadar
- Helen-Schneider-Hospital for Women, Rabin Medical Center, Petah Tikva, Israel
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Kives S, Gascon S, Dubuc É, Van Eyk N. No. 341-Diagnosis and Management of Adnexal Torsion in Children, Adolescents, and Adults. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 39:82-90. [PMID: 28241927 DOI: 10.1016/j.jogc.2016.10.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To review the evidence and provide recommendations on the diagnosis and management of adnexal torsion in children, adolescents, and women. OUTCOMES Elements evaluated include the risk factors, diagnostic accuracy, management options, and outcomes of adnexal torsion. EVIDENCE Published literature was retrieved through searches of MEDLINE, Embase, CINAHL, and the Cochrane Library using appropriate controlled vocabulary and key words ("adnexal torsion," "ovarian torsion"). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. Searches were updated on a regular basis and new material incorporated in the guideline to December 2014. Grey (unpublished) literature was identified through searching the websites of health technology assessment and related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. VALUES The evidence obtained was reviewed and evaluated by the Canadian Paediatric and Adolescent Gynaecology and Obstetrics Committee of the Society of Obstetricians and Gynaecologists of Canada (SOGC) under the leadership of the principal authors. Recommendations were made according to guidelines developed by the Canadian Task Force on the Periodic Health Examination. BENEFITS, HARMS AND COSTS Guideline implementation should assist the practitioner in developing an optimal approach to the diagnosis and management of adnexal torsion while minimizing harm and improving patient outcomes. VALIDATION These guidelines have been reviewed and approved by the Gynaecology Committee of the SOGC and approved by the council of the SOGC. SPONSOR The Society of Obstetricians and Gynaecologists of Canada SUMMARY STATEMENTS: RECOMMENDATIONS.
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Rialon KL, Akinkuotu A, Fahy AS, Shelmerdine S, Traubici J, Chiu P. Management of ovarian lesions diagnosed during infancy. J Pediatr Surg 2019; 54:955-958. [PMID: 30795909 DOI: 10.1016/j.jpedsurg.2019.01.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 01/27/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Prior studies of infant ovarian cysts have recommended intervention for those larger than 4 cm. We reviewed the natural history and features of those managed operatively versus nonoperatively. METHODS A retrospective study was performed of ovarian lesions in children <1 year-old from 2000 to 2014. RESULTS Forty patients were identified. Twenty-eight (70%) underwent operative management, while 12 (30%) were managed conservatively, including one undergoing aspiration. The mean age at surgery was 125 days. All but one patient (96%) had evidence of antenatal torsion intraoperatively or on final pathology. All resected lesions were benign. Ultrasound findings more common in those undergoing surgery included intracystic debris (p < 0.001), fluid-fluid or fluid-debris levels (p = 0.002), absence of Doppler flow (p = 0.014), solid components (p = 0.04), and calcifications (p = 0.001). Cysts managed nonoperatively had an average diameter of 2.5 cm, compared to 5.1 cm in the operative group (p < 0.001). Three of the lesions managed nonoperatively had a diameter greater than 3.5 cm (mean 5.1 cm) and were followed for an average of 153 days until resolution. CONCLUSIONS The majority of infant ovarian lesions were excised, although none were malignant. Aspiration or observation of larger cysts was feasible and safe. Ovarian cysts in this age group should be considered for nonoperative management and closely followed. LEVEL OF EVIDENCE IIC.
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Affiliation(s)
- Kristy L Rialon
- Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Adesola Akinkuotu
- Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Aodhnait S Fahy
- Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Susan Shelmerdine
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Jeffrey Traubici
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Priscilla Chiu
- Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
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Dasgupta R, Renaud E, Goldin AB, Baird R, Cameron DB, Arnold MA, Diefenbach KA, Gosain A, Grabowski J, Guner YS, Jancelewicz T, Kawaguchi A, Lal DR, Oyetunji TA, Ricca RL, Shelton J, Somme S, Williams RF, Downard CD. Ovarian torsion in pediatric and adolescent patients: A systematic review. J Pediatr Surg 2018; 53:1387-1391. [PMID: 29153467 DOI: 10.1016/j.jpedsurg.2017.10.053] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 10/19/2017] [Accepted: 10/20/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Ovarian torsion in pediatric patients is a rare event and is primarily managed by pediatric general surgeons. Torsion can be treated with detorsion of the ovary or oopherectomy. Oopherectomy is the most common procedure performed by pediatric general surgeons for ovarian torsion. The purpose of this systematic review by the American Pediatric Surgical Association Outcomes and Evidence Based Practice Committee was to examine evidence from the medical literature and provide recommendations regarding the optimal treatment of ovarian torsion. METHODS Using PRISMA guidelines, six questions were addressed by searching Medline, Cochrane, Embase Central and National clearing house databases using relevant search terms. Risks of ovarian detorsion including thromboembolism and malignancy, indications for oophoropexy, benefits of detorsion including recovery of function and subsequent fertility, and recommended surveillance after detorsion were evaluated. Consensus recommendations were derived for each question based on the best available evidence. RESULTS Ninety-six studies were included. Risks of ovarian detorsion such as thromboembolism and malignancy were reviewed, demonstrating minimal evidence for unknowingly leaving a malignancy behind in the salvaged ovary and no evidence in the literature of thromboembolic events after detorsion of a torsed ovary. There is no clear evidence supporting the benefit of oophoropexy after a single episode of ovarian torsion. The gross appearance of the ovary does not correlate with long-term ovarian viability or function. Pregnancies have occurred in patients after detorsion of an ovary both spontaneously and with harvested oocytes from previously torsed ovaries. The consensus recommendation for imaging surveillance following ovarian detorsion is an ultrasound at 3months postprocedure but sooner if there is a concern for malignancy. CONCLUSION There appears to be overwhelming evidence supporting ovarian detorsion rather than oopherectomy for the management of ovarian torsion in pediatric patients. Ovarian salvage is safe and is the preferred treatment for ovarian torsion. Most salvaged ovaries will maintain viability after detorsion. TYPE OF STUDY Systematic review of level 3-4 studies. LEVEL OF EVIDENCE 3-4.
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Affiliation(s)
- Roshni Dasgupta
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Medical Center, Cincinnati, OH.
| | - Elizabeth Renaud
- Department of Surgery, Division of Pediatric Surgery Albany Medical College, Albany, NY
| | - Adam B Goldin
- Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA
| | - Robert Baird
- Division of Pediatric General and Thoracic Surgery, Montreal Children's Hospital, Montreal, QC
| | | | - Meghan A Arnold
- Section of Pediatric Surgery, CS Mott Children's Hospital, Ann Arbor, MI
| | - Karen A Diefenbach
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH
| | - Ankush Gosain
- Division of Pediatric Surgery, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, TN
| | - Julia Grabowski
- Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Yigit S Guner
- Division of Pediatric General and Thoracic Surgery Children's Hospital Orange County, University of California Irvine
| | - Tim Jancelewicz
- Division of Pediatric Surgery, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, TN
| | - Akemi Kawaguchi
- Department of Pediatric Surgery, Mc Govern Medical School at the University of Texas Health Science Center at Houston
| | - Dave R Lal
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | | | - Robert L Ricca
- Division of Pediatric Surgery, Naval Medical Center, Portsmouth, VA
| | - Julia Shelton
- Division of Pediatric Surgery, University of Iowa Stead Family Children's Hospital, Iowa City, IA
| | - Stig Somme
- Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado, Aurora, Colorado
| | - Regan F Williams
- Division of Pediatric Surgery, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, TN
| | - Cynthia D Downard
- Division of Pediatric Surgery, Hiram C. Polk, Jr, MD Department of Surgery, University of Louisville, Louisville, KY
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Chu K, Zhang Q, Sun N, Ding H, Li W. Conservative laparoscopic management of adnexal torsion based on a 17-year follow-up experience. J Int Med Res 2018; 46:1685-1689. [PMID: 29486636 PMCID: PMC6091833 DOI: 10.1177/0300060517754025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Laparoscopic unwinding of adnexal torsion has been proposed for decades. However, this technique is still controversial regarding the concern of thromboembolic events. We present two cases of conservative laparoscopic management of adnexal torsion. In the first case, a 16-year-old adolescent with serous cystadenoma was successfully managed by untwisting and cystectomy. We followed up this patient for 17 years with regular re-examinations in our hospital. To the best of our knowledge, this is the longest follow-up reported of this condition. In the second case, a 32-year-old infertile woman who received oocyte retrieval 3 days before being admitted to hospital was referred to hospital with right ovarian torsion. We treated her successfully based on our long-term follow-up experience, and she is now asymptomatic and in her 7th month of pregnancy.
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Affiliation(s)
- Kun Chu
- Reproductive Medicine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Qing Zhang
- Reproductive Medicine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Ningxia Sun
- Reproductive Medicine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Haixia Ding
- Reproductive Medicine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Wen Li
- Reproductive Medicine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China
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Wade TMM, Diagne M, Ba PA, Diao ML, Konaté I. Ovarian Torsion: Report of 27 Cases at Surgical Department of Aristide Le Dantec Teaching Hospital of Dakar, Senegal. J Gynecol Surg 2017. [DOI: 10.1089/gyn.2017.0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Thomas Marcel Mbar Wade
- General Surgery Department, Aristide Le Dantec Teaching Hospital of Dakar, Dakar, Senegal
- Faculty of Health Sciences, University of Thies, Thies, Senegal
| | - Mohamadou Diagne
- General Surgery Department, Aristide Le Dantec Teaching Hospital of Dakar, Dakar, Senegal
| | | | - Mohamed Lamine Diao
- Department of General Surgery, Gaston Berger University of St. Louis, St. Louis, Senegal
| | - Ibrahima Konaté
- Department of General Surgery, Gaston Berger University of St. Louis, St. Louis, Senegal
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Kives S, Gascon S, Dubuc É, Van Eyk N. N° 341-Diagnostic et prise en charge de la torsion annexielle chez les filles, les adolescentes et les femmes adultes. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 39:91-100. [DOI: 10.1016/j.jogc.2016.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Yasa C, Dural O, Bastu E, Zorlu M, Demir O, Ugurlucan FG. Impact of laparoscopic ovarian detorsion on ovarian reserve. J Obstet Gynaecol Res 2016; 43:298-302. [PMID: 27928855 DOI: 10.1111/jog.13195] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 09/07/2016] [Indexed: 11/27/2022]
Abstract
AIM The aim of this study was to evaluate ovarian reserve after laparoscopic ovarian detorsion in patients with ovarian torsion. METHODS From February 2014 to September 2015, a total of 11 patients with ovarian torsion underwent laparoscopic detorsion. These 11 patients were eligible for study, and ovarian reserve was assessed on serum anti-Müllerian hormone (AMH) and by antral follicle count preoperatively, and in postoperative months 1 and 3. RESULTS Mean patient age was 25.4 ± 5.5 years. Although mean antral follicle count on the operated side was slightly lower than on the contralateral side at 1 month postoperatively (P > 0.05), at 3 months postoperatively there was no difference in mean antral follicle count between the operated and contralateral sides (P > 0.05). There was no significant change in serum AMH level at 1 and 3 months postoperatively compared with the preoperative level (P > 0.05). CONCLUSIONS Laparoscopic detorsion of twisted ovary is a safe procedure to preserve ovarian function, and does not impair ovarian reserve according to antral follicle count and AMH during the course of follow-up.
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Affiliation(s)
- Cenk Yasa
- Department of Obstetrics and Gynecology, Istanbul University School of Medicine, Istanbul, Turkey
| | - Ozlem Dural
- Department of Obstetrics and Gynecology, Istanbul University School of Medicine, Istanbul, Turkey
| | - Ercan Bastu
- Department of Obstetrics and Gynecology, Istanbul University School of Medicine, Istanbul, Turkey
| | - Masallah Zorlu
- Department of Obstetrics and Gynecology, Istanbul University School of Medicine, Istanbul, Turkey
| | - Omer Demir
- Department of Obstetrics and Gynecology, Istanbul University School of Medicine, Istanbul, Turkey
| | - Funda Gungor Ugurlucan
- Department of Obstetrics and Gynecology, Istanbul University School of Medicine, Istanbul, Turkey
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Characteristics and Management of Ovarian Torsion in Premenarchal Compared With Postmenarchal Patients. Obstet Gynecol 2015; 126:514-520. [DOI: 10.1097/aog.0000000000000995] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nur Azurah AG, Zainol ZW, Zainuddin AA, Lim PS, Sulaiman AS, Ng BK. Update on the management of ovarian torsion in children and adolescents. World J Pediatr 2015; 11:35-40. [PMID: 25557598 DOI: 10.1007/s12519-014-0536-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 09/05/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Ovarian torsion is commonly seen in young girls. Unfortunately it is often misdiagnosed because of its non-specific symptoms and lack of diagnostic modalities. This article focuses on the diagnostic challenge and also the changes in the management of ovarian torsion. DATA SOURCES We reviewed original reports on the management of ovarian torsion in young girls published from 1984 till 2014. A literature search was conducted by electronic scanning of five electronic database: MEDLINE, EMBASE, SCI, SSCI and CINAHL. In addition, relevant papers and review articles were hand-searched. The search was limited to English language and human studies. The search was conducted by combining the textwords "ovarian torsion", "adnexal torsion", "adolescents" and "oophoropexy". RESULTS There are no specific symptoms that can be identified as a pathognomonic feature of ovarian torsion. Ultrasound is a useful diagnostic tool, but it is not always reliable in absence of an enlarged ovary. Laparoscopic detorsion is recognized as the mainstay of treatment regardless the condition of the ovaries. Reports have shown favorable ovarian function after detorsion. The role of oopheropexy remains controversial. CONCLUSIONS Clinicians should be aware of ovarian torsion in girls presenting with abdominal pain. A timely management in this young population can help preserve their ovaries and fertility.
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Fujishita A, Araki H, Yoshida S, Hamaguchi D, Nakayama D, Tsuda N, Khan KN. Outcome of conservative laparoscopic surgery for adnexal torsion through one-stage or two-stage operation. J Obstet Gynaecol Res 2014; 41:411-7. [DOI: 10.1111/jog.12534] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Accepted: 07/09/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Akira Fujishita
- Department of Gynecology; Saiseikai Nagasaki Hospital; Nagasaki Japan
| | - Hiroyuki Araki
- Department of Gynecology; Saiseikai Nagasaki Hospital; Nagasaki Japan
| | - Shiko Yoshida
- Department of Gynecology; Saiseikai Nagasaki Hospital; Nagasaki Japan
| | - Daisuke Hamaguchi
- Department of Gynecology; Saiseikai Nagasaki Hospital; Nagasaki Japan
| | - Daisuke Nakayama
- Department of Gynecology; Saiseikai Nagasaki Hospital; Nagasaki Japan
| | - Nobuo Tsuda
- Department of Pathology; Nagasaki Health Promotion Corporation; Nagasaki Japan
| | - Khaleque Newaz Khan
- Department of Obstetrics and Gynecology; Graduate School of Biomedical Sciences, Nagasaki University; Nagasaki Japan
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Bozdag G, Demir B, Calis PT, Zengin D, Dilbaz B. The Impact of Adnexal Torsion on Antral Follicle Count when Compared With Contralateral Ovary. J Minim Invasive Gynecol 2014; 21:632-5. [DOI: 10.1016/j.jmig.2014.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 01/03/2014] [Accepted: 01/06/2014] [Indexed: 01/09/2023]
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Yucel B, Usta TA, Kaya E, Turgut H, Ates U. Folicular reserve changes in torsion-detorsion of the ovary: an experimental study. Eur J Obstet Gynecol Reprod Biol 2014; 177:126-9. [PMID: 24774035 DOI: 10.1016/j.ejogrb.2014.03.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Revised: 02/27/2014] [Accepted: 03/31/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE We assess follicular reserve changes by follicle count in torsion-detorsion rat model. STUDY DESIGN 30 albino rats were randomly divided into 3 groups: sham group (SG), detorsion after 24-hour torsion group (24hTG) and detorsion after 72-hour torsion group (72hTG). Ovaries were torsioned and fixed. They were untwisted 24 and 72 h later. Oophorectomies were performed at 14th day after detorsion. Tissue damage scoring and follicle counts were evaluated microscopically. RESULTS Tissue damage scores (TDSs) were higher in 72hTG and 24hTG compared to SG. In addition, as we increase torsion duration, TDSs also increased. There was no statistically significant difference in follicle numbers (primordial, primary, secondary and tertiary). CONCLUSION Duration of torsion and intensity of ovarian damage do not affect follicular reserve in a rat model. Regardless of their macroscopic appearance, ovaries maintain their follicle reserves after torsion. Thus, surgeons should be reassured and encouraged to untwist torsioned ovaries rather than removing them.
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Affiliation(s)
- Burak Yucel
- Department of Obstetrics and Gynecology, Acıbadem Hospital, Kayseri, Turkey
| | - Taner A Usta
- Department of Obstetrics and Gynecology, Bagcilar Training and Research Hospital, Bagcilar, Istanbul, Turkey.
| | - Erdal Kaya
- Department of Obstetrics and Gynecology, Bagcilar Training and Research Hospital, Bagcilar, Istanbul, Turkey
| | - Hurriyet Turgut
- Department of Pathology, Bakirkoy Sadi Konuk Training and Research Hospital, Bakirkoy, Turkey
| | - Ugur Ates
- Department of Obstetrics and Gynecology, Haseki Training and Research Hospital, Bagcilar, Istanbul, Turkey
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Sasaki KJ, Miller CE. Adnexal Torsion: Review of the Literature. J Minim Invasive Gynecol 2014; 21:196-202. [DOI: 10.1016/j.jmig.2013.09.010] [Citation(s) in RCA: 131] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 09/02/2013] [Accepted: 09/03/2013] [Indexed: 11/28/2022]
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Deffieux X, Thubert T, Huchon C, Demoulin G, Rivain AL, Faivre E, Trichot C. [Complications of presumed benign ovarian tumors]. ACTA ACUST UNITED AC 2013; 42:816-32. [PMID: 24210240 DOI: 10.1016/j.jgyn.2013.09.036] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The main risk factor of adnexal torsion is a previous adnexal torsion (LE3). There is no clinical, biological or radiological sign that may exclude the diagnosis of adnexal torsion (LE3). The presence of flow at color Doppler imaging does not allow exclusion of the diagnosis (LE2). An emergent laparoscopy is recommended for adnexal untwisting (Grade B), except in postmenopausal women where oophorectomy is recommended (grade C). A persistent black color of the adnexa after untwisting is not an indication for systematic oophorectomy (grade C), since a functional recovery is possible (LE3). Ovariopexy is not routinely recommended following adnexal untwisting (grade C). The clinical signs of intra-cystic hemorrhage and those of rupture of the corpus luteum are not specific (LE4). MRI is not recommended to confirm the diagnosis of intra-cystic hemorrhage (grade C). Malignant transformation of an ovarian cyst is very rare. The presence of a benign ovarian cyst is not associated with an increased risk of ovarian cancer at long-term follow-up (LE2). For these women, an ultrasound follow-up is not recommended (grade C). Dermoid ovarian cyst containing nerve tissue can trigger the production of pathogenic auto-antibody-anti-NMDA, leading to encephalitis. A high proportion of thyroid tissue in a mature teratoma (struma ovarii) may cause hyperthyroidism.
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Affiliation(s)
- X Deffieux
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France; Faculté de médecine, université Paris-Sud, 91405 Orsay, France.
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Ginath S, Shalev A, Keidar R, Kerner R, Condrea A, Golan A, Sagiv R. Differences between adnexal torsion in pregnant and nonpregnant women. J Minim Invasive Gynecol 2013; 19:708-14. [PMID: 23084674 DOI: 10.1016/j.jmig.2012.07.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2012] [Revised: 07/24/2012] [Accepted: 07/26/2012] [Indexed: 10/27/2022]
Abstract
STUDY OBJECTIVE To compare the clinical manifestation, management, and outcome of adnexal torsion in pregnant and nonpregnant women. DESIGN Retrospective case-control study (Canadian Task Force classification II-3). SETTING Tertiary care university hospital. PATIENTS Sixty-four pregnant women and 198 nonpregnant women with episodes of adnexal torsion. INTERVENTIONS Surgery to treat proved adnexal torsion. MEASUREMENTS AND MAIN RESULTS The mean (SD) gestational age in the pregnant group was 11.5 (7.7) weeks. Thirty six episodes of adnexal torsion in the pregnant group (56%) developed after treatment for infertility, compared with only 14 such episodes (7%) in the nonpregnant group (p < .001). A repeated episode of torsion occurred more frequently in the pregnant group (14% vs 4%; p = .03). Sonographic demonstration of multicystic ovaries was more common in pregnant women with recurrent torsion than in women with a single episode of torsion (86% vs 31%; p = .009). Tissue preservation was achieved more frequently in pregnant than in nonpregnant patients (95% vs 77%; p < .001), and the duration of surgery was 15 minutes shorter in the pregnant women (p < .001). CONCLUSION Pregnancy after treatment for infertility is a risk factor for adnexal torsion. Recurrence of ovarian torsion occurs more frequently in pregnant patients, and in particular in enlarged multicystic ovaries.
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Affiliation(s)
- Shimon Ginath
- Department of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, Israel.
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Piper HG, Oltmann SC, Xu L, Adusumilli S, Fischer AC. Ovarian torsion: diagnosis of inclusion mandates earlier intervention. J Pediatr Surg 2012; 47:2071-6. [PMID: 23164000 DOI: 10.1016/j.jpedsurg.2012.06.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Revised: 06/14/2012] [Accepted: 06/20/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE The treatment of ovarian torsion (OT) is often delayed because of diagnostic uncertainty and dependence on radiologic confirmation. In contrast, when testicular torsion (TT) is suspected, diagnosis and management are expedited despite lack of certainty, and operative exploration is not delayed by radiologic investigations. We compared the management of torsion in both sexes to define a better clinical pathway for suspected OT. METHODS A 2.5-year review of the Pediatric Health Information System database was performed to determine the incidence of TT and OT at large children's hospitals. A 10-year retrospective review of children (0-19 years) diagnosed with TT or OT at a single academic center was performed to identify differences in diagnosis and management and determine the impact on gonadal salvage rates. RESULTS The incidence of TT was comparable with OT in the Pediatric Health Information System database (0.03% vs 0.02%). A total of 158 patients with TT and 90 patients with OT were managed at our center with a median age of 12 years in both groups. Boys presented earlier after the onset of pain (36 vs 72 hours, P < .0001) and were imaged more quickly (0.77 vs 1.86 hours, P < .0001). Time to operating room (OR) was also shorter for TT (2.3 vs 6.3 hours, P < .0001). The salvage rate for TT was 30.3% vs 14.4% for OT (P < .01). CONCLUSIONS Girls with suspected OT waited 2.5 times as long for diagnostic imaging and 2.7 times as long to be taken to the operating room. In addition, the gonadal salvage rate was significantly worse for girls compared with boys with TT. More urgent intervention for OT, with liberal use of diagnostic laparoscopy and without reliance on a definitive diagnosis by imaging, should be considered in girls with lower abdominal pain.
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Affiliation(s)
- Hannah G Piper
- Division of Pediatric Surgery, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada.
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Affiliation(s)
- Emmanuel Damigos
- ST5 in Obstetrics and Gynaecology; Friarage Hospital, South Tees Hospitals Trust; Northallerton, North Yorkshire; DL6 1JG; UK
| | - Jemma Johns
- Consultant Gynaecologist, King's College Hospital; Denmark Hill, London; SE5 9RS; UK
| | - Jackie Ross
- Consultant Obstetrician and Gynaecologist; King's College Hospital; Denmark Hill, London; SE5 9RS; UK
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Karayalçın R, Ozcan S, Ozyer S, Var T, Yeşilyurt H, Dumanlı H, Soysal S, Mollamahmutoğlu L, Batıoğlu S. Conservative laparoscopic management of adnexal torsion. J Turk Ger Gynecol Assoc 2011; 12:4-8. [PMID: 24591949 DOI: 10.5152/jtgga.2011.02] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2010] [Accepted: 12/17/2010] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate our experience with adnexal torsion (AT) in 36 patients and the outcomes of the patients who were managed conservatively via laparoscopy. MATERIAL AND METHODS A prospective study was conducted on 36 patients who underwent operations for AT via laparoscopy between January 2008 and December 2009. Data including age, previous history, time of onset of symptoms, time of admission to hospital, gray-scale and color Doppler US findings, time interval between hospital admission and surgery, type of intervention, operative findings and postoperative gray-scale and Doppler US findings were recorded. RESULTS In 29 (80.5%) patients, a preoperative diagnosis of AT was confirmed clinically. The mean age of the patients was 26.5, with a range of 11 to 44. Ovarian blood flow was assessed by color Doppler US ultrasonography in 30 patients preoperatively. In 11 (36.6%) patients, this was found to be normal. In 19 (63.3%) patients, ovarian blood flow was found to be pathological or absent. Laparoscopic conservative treatment was performed in 34 patients. In two patients, salpingo-oophorectomy was performed. No thromboembolic complications were seen. Postoperative ultrasonographic examinations confirmed normal ovarian morphology and Doppler blood flow in all patients with no recurrence. CONCLUSION Early diagnosis and treatment are key factors in managing AT. According to the results of the present study, given its demonstrated safety and benefits, in women of reproductive age, a conservative approach of untwisting the adnexa and salvaging the ovary via laparoscopy should be considered in AT cases in which the time from the onset of symptoms to surgery does not exceed 44 hours, regardless of the color and number of twists.
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Affiliation(s)
- Rana Karayalçın
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
| | - Sarp Ozcan
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
| | - Sebnem Ozyer
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
| | - Turgut Var
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
| | - Hüseyin Yeşilyurt
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
| | - Hüseyin Dumanlı
- Department of Radiology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
| | - Sunullah Soysal
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
| | - Leyla Mollamahmutoğlu
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
| | - Sertaç Batıoğlu
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
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Huchon C, Fauconnier A. Adnexal torsion: a literature review. Eur J Obstet Gynecol Reprod Biol 2010; 150:8-12. [DOI: 10.1016/j.ejogrb.2010.02.006] [Citation(s) in RCA: 133] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Revised: 12/16/2009] [Accepted: 02/02/2010] [Indexed: 10/19/2022]
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Guthrie BD, Adler MD, Powell EC. Incidence and trends of pediatric ovarian torsion hospitalizations in the United States, 2000-2006. Pediatrics 2010; 125:532-8. [PMID: 20123766 DOI: 10.1542/peds.2009-1360] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE There is significant variation in the literature regarding the characteristics that are associated with pediatric ovarian torsion and its management. National data regarding the demographics and management of pediatric ovarian torsion are lacking. Our objective was to describe the epidemiology of pediatric ovarian torsion and the rate of oophorectomy by using nationally representative data. Demographic factors and hospital characteristics that are associated with rates of oophorectomy were also explored. METHODS This was a cohort analysis of the Healthcare Cost and Utilization Project Kids' Inpatient Database (KID) 2000, 2003, and 2006. All females aged 1 to 20 years who were hospitalized with ovarian torsion in states participating in KID 2000, KID 2003, and KID 2006 representing 900, 1224, and 1232 ovarian torsion-related hospitalizations, respectively, were included. Primary outcome measures included the incidence of ovarian torsion and rate of associated oophorectomy. Multivariable regression was used to control for patient and hospital characteristics. RESULTS Among females aged 1 to 20 years, there were 1232 cases of ovarian torsion in KID 2006, an estimated incidence of 4.9 per 100000. A total of 713 (58%) were treated with oophorectomy. The rate of ovarian torsion-associated oophorectomy remained unchanged from 2000 to 2006. The adjusted odds of having an oophorectomy decreased by 0.95 for every increasing year of age. Residing in a lower quartile of household income by zip code increased the adjusted odds of oophorectomy. A diagnosis of benign neoplasm increased the adjusted odds of oophorectomy by 2.16. Fewer than 0.5% of ovarian torsion hospitalizations were associated with malignant neoplasm. CONCLUSIONS Nationally representative hospital data indicate that ovarian torsion is uncommon but occurs in all ages and is typically associated with normal ovaries or benign lesions. Improved awareness of the epidemiology may help to guide management. Ongoing analysis to identify factors that are associated with successful conservative management is warranted.
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Affiliation(s)
- Bridgette D Guthrie
- Children's Memorial Hospital, Division of Pediatric Emergency Medicine, 2300 Children's Plaza, Box 62, Chicago, IL 60614, USA.
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Hernon M, McKenna J, Busby G, Sanders C, Garden A. The histology and management of ovarian cysts found in children and adolescents presenting to a children’s hospital from 1991 to 2007: a call for more paediatric gynaecologists. BJOG 2009; 117:181-4. [DOI: 10.1111/j.1471-0528.2009.02433.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bottomley C, Bourne T. Diagnosis and management of ovarian cyst accidents. Best Pract Res Clin Obstet Gynaecol 2009; 23:711-24. [DOI: 10.1016/j.bpobgyn.2009.02.001] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Accepted: 02/03/2009] [Indexed: 11/25/2022]
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Lo LM, Chang SD, Horng SG, Yang TY, Lee CL, Liang CC. Laparoscopy versus laparotomy for surgical intervention of ovarian torsion. J Obstet Gynaecol Res 2009; 34:1020-5. [PMID: 19012702 DOI: 10.1111/j.1447-0756.2008.00806.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To review the clinical manifestations of ovarian torsion (OT) and to compare the surgical results between laparoscopy and laparotomy. METHODS From 1997 to 2006, data on 179 patients admitted to a medical center with surgically proven OT were collected. We compared patients' symptom presentations, objective findings and surgical outcomes between patients who underwent laparotomy and those who received laparoscopy, and between patients admitted via the emergency room and those via the outpatient department. RESULTS The most common symptom and sign was pelvic pain (82.1%), followed by nausea and vomiting (49.7%), elevated white blood count (20.1%), lower urinary tract symptoms (14.5%) and fever (7.8%). An adnexal or pelvic mass could be detected using gynecological ultrasound in almost all of the patients (98.3%). Ovarian torsion was considered among the admission differential diagnoses in 51.4% of patients. One hundred and five patients (58.7%) seen in the emergency room were more likely to present with nausea and vomiting, sudden pain onset and peritoneal signs than those seen in the outpatient department. Patients undergoing laparoscopy had a smaller sized ovarian mass; they were less likely to require oophorectomy; they had a shorter hospital stay; and fewer of them suffered from postoperative fever compared to patients undergoing laparotomy. Discriminant analysis showed that mass size was the single determining factor for choice of operating methods. CONCLUSION The diagnosis of OT is missed in half of the patients because clinical features are unspecific and objective findings are uncommon. The laparoscopy procedure for ovarian conservation is recommended to treat patients suffering from OT owing to its shorter hospital stay, fewer postoperative complications and ovarian preservation.
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Affiliation(s)
- Liang-Ming Lo
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Taoyuan, Taiwan
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Abstract
PURPOSE OF REVIEW The acute abdomen remains a challenge for all physicians who take part in the care of women in pregnancy. Obstetricians must be abreast of current topics, especially critical when having to consult other specialties for assistance in managing these conditions. RECENT FINDINGS We will highlight recent observations in the literature concerning the ability to perform laparoscopy safely in pregnancy, the accuracy of diagnosing appendicitis, and new methods to accurately diagnose urolithiasis with less ionizing radiation effect on the fetus. Finally, with the proficiency of laparoscopy and choledochoscopy improving, we will review several articles underlining their safety. SUMMARY Laparoscopy appears to be well tolerated in pregnancy, but larger multicenter prospective studies are required to make better recommendations concerning its use, with a registry needed to facilitate this endeavor. Conservative management of gallstone pancreatitis may fall out of favor, and choledochoscopy for symptomatic gallstones in the biliary tree may become the treatment of choice. Most cases of urolithiasis resolve with conservative management, but the possibility of preterm labor in these patients must be recognized and newer imaging techniques for diagnosis containing less radiation be used. Adnexal torsion in pregnancy may be another condition that is managed through the laparoscope as the gynecologic community's laparoscopic skills improve.
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Tandulwadkar S, Shah A, Agarwal B. Detorsion and conservative therapy for twisted adnexa: our experience. JOURNAL OF GYNECOLOGICAL ENDOSCOPY AND SURGERY 2009; 1:21-6. [PMID: 22442506 PMCID: PMC3304263 DOI: 10.4103/0974-1216.51905] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Objective: 1) To determine if detorsion of the twisted adnexa is better than traditional adnexectomy to conserve the adnexa and preserve its function. 2) To determine the feasibility of detorsion in conservation of adnexa. Design: Prospective Study from September 2004 to September 2008. Setting: Private IVF and Endoscopy Centre. Patients: 22 patients with twisted adnexa (15 non-pregnant and 7 pregnant). Intervention: Surgical intervention and either detorsion of adnexa or adnexectomy. Main Outcome Measures: Ovarian preservation and conservation of ovarian function in 77.2% cases determined by: a) Follicular development on sonography (performed for one year after adnexectomy). b) Subsequent surgery for unrelated cause showing healthy ovaries. c) controlled ovarian hyperstimulation and successful oocyte retrieval subsequently. Results: We could conserve the adenexa in 77.2% cases. Laparoscopic detorsion was performed in 11/15(73.33 %) of non-pregnant women and adnexectomy done in four women 26.66%. Among the seven pregnant women, adnexa could be preserved in 6/7(85.7%) and only one woman required adnexectomy. Laparotomy was required in 2/22(9%) women both of which were in late second trimester of pregnancy. In one case (4.54%) we had recurrence of torsion. 88.23% of the women with conserved adnexa showed preservation of ovarian function. Conclusion: Our study showed that timely diagnosis and intervention could make the difference between ovarian loss and salvage- an outcome of great importance in population of reproductive age females. Laparoscopy with its many benefits proves to be superior to laparotomy.
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Abstract
This review provides timely information concerning clinical, surgical, and pathologic findings of adnexal torsion (AT). AT mostly occurs in the child-bearing age group, but is not uncommon in premenarchal girls or postmenopausal women. When AT is suspected, urgent surgical intervention is indicated, and is usually performed by laparoscopy. Incidence of AT is 3.5% of all benign cystic teratomas. Despite the "necrotic" appearance of the twisted ischemic ovary, detorsion is the only procedure which should be performed at surgery. Adnexectomy should be avoided as ovarian function is preserved in 88% to 100% of cases. Awareness and suspicion of the diagnosis of AT is needed in patients who present with lower abdominal pain.
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Abstract
PURPOSE OF REVIEW This review provides timely information to assist in solving the diagnostic dilemma of adnexal or ovarian torsion. Knowledge and awareness of current literature is essential to help clinicians improve diagnostic accuracy and avoid potentially catastrophic consequences, including loss of ovarian tissue and function. RECENT FINDINGS This article reviews recent evidence regarding radiologic tools used for efficient, timely diagnosis and management strategies for adnexal torsion, including detorsion. The role of oophoropexy in the pediatric and adolescent population is also reviewed. SUMMARY The discussion reinforces the role of detorsion in lieu of oophorectomy or adnextomy in an effort to preserve reproductive capacity in a young population. Long-term follow-up, including reproductive outcomes, is needed to determine the role of oophoropexy.
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Affiliation(s)
- Lesley L Breech
- Department of Pediatrics, Department of Obstetrics & Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
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Abstract
An 18-year-old female presented with a 6-day history of lower abdominal pain. Transabdominal ultrasonography revealed a right adnexal cyst measuring 9 cm. Laparoscopic examination demonstrated a 10-cm right paratubal cyst and a 5-cm right ovarian torsion with gangrenous discoloration. After removal of the right paratubal cyst, untwisting of the right ovary was performed. The postoperative period was uneventful. During follow-up, ultrasonography revealed restoration of right ovarian size with follicular growth. Arterial and venous blood flows were seen on Doppler examination. The right ovary appeared to be completely viable through a second-look laparoscopic examination. A twisted ovary may be completely restored with conservative management.
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Affiliation(s)
- Yiu-Tai Li
- Department of Obstetrics and Gynecology, Kuo General Hospital, Tainan, Taiwan, ROC.
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Geist RR, Rabinowitz R, Zuckerman B, Shen O, Reinus C, Beller U, Lara-Torre E. Massive edema of the ovary: a case report and review of the pertinent literature. J Pediatr Adolesc Gynecol 2005; 18:281-4. [PMID: 16171733 DOI: 10.1016/j.jpag.2005.05.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Massive edema of the ovary is a rare entity affecting mainly young women. It is often misdiagnosed for a malignancy, posing the young patient at risk for over-treatment with resultant loss of hormonal function and fertility. CASE A 13-year-old premenarchal girl presented with a large solid pelvic mass after recurrent episodes of self-limited abdominal pain. With a working diagnosis of malignant ovarian tumor, an exploratory laparotomy was done in which a twisted ovarian mass was found and excised completely. Pathological examination of the mass revealed massive edema of the ovary with hemorrhagic necrosis. CONCLUSION After extensive review of the literature, it seems most cases were over-treated, as was ours. This entity should be suspected in women at the fertile age range with solid enlargement of the ovary and definite treatment should be undertaken only after confirmed pathological diagnosis. Conservative treatment is feasible and should be the rule in these cases, where fertility preservation is mandatory.
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Affiliation(s)
- Ruth R Geist
- Department of Obstetrics and Gynecology, Milford Memorial Hospital, Delaware, USA
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Abstract
OBJECTIVE To define the presenting symptoms and clinical progress of surgically proven cases of ovarian torsion presenting to a tertiary women's hospital. METHODS A retrospective case review of surgically proven ovarian torsion at The Royal Women's Hospital, Melbourne between 8 May 1990 and 8 May 2000. RESULTS Fifty-two cases were identified. Median age at presentation was 33.5 years (interquartile range [IQR]: 28.7-39.3). Known risk factors at presentation were found in 16 (30.8%, 95% CI: 26.9-34.6%) cases including 6/49 (12.2%, 95% CI 11.1-12.4%) with ovarian hyperstimulation syndrome. The main clinical features included: sudden pain (20/23, 87%, 95% CI 75-98.9%), nausea/vomiting (23/39, 59%, 95% CI 49.9-68.1%) and palpable abdominal mass (23/37, 62.2%, 95% CI 52.4-71.9%). Median symptom duration was 3 days (IQR: 1-7.25). Median time to diagnosis was 22 h (IQR: 7.8-55.0). The diagnosis was mostly made at surgery (36, 69.2%, 95% CI 60.5-77.9%) with clinically suspicion in 10 (19.2%, 95% CI 17.2-21.3%) and sonographic suspicion/confirmation in six (11.5%, 95% CI 10.5-12.5%) cases. Ultrasound was performed in 31 (59.6%, 95% CI 51.7-67.6%) cases. Underlying pathologies included: ovarian cysts (27, 51.9%, 95% CI 44.9-59.0%) and tumours (16, 30.8%, 95% CI 26.9-34.6%)--mostly benign. Ovarian preservation occurred in 16 (30.8%, 95% CI 26.9-34.6%) cases with no demonstrable association to patient age, time to diagnosis or known risk factors. CONCLUSION The diagnosis of ovarian torsion remains challenging. Clinical characteristics lack sensitivity and specificity and ultrasound diagnosis is not definitive. Laparoscopy remains the investigation of choice. Despite delays in diagnosis this study demonstrates relatively high ovarian salvage rates compared with most published data.
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Affiliation(s)
- Melissa White
- Emergency Department, The Geelong Hospital, Geelong, Victoria, Australia.
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Abstract
BACKGROUND/PURPOSE Adnexal torsion is a condition that may result in serious morbidity including adnexal removal. However, conservative management with preserving the torsed adnexa is not justified, and long-term outcomes remain unclear. METHODS The records of 14 girls with ovarian torsion whose adnexal structures were preserved after detorsion were reviewed to evaluate the long-term results of conservative management. Data including age, previous history, duration of complaints, surgical findings and type of intervention, color Doppler ultrasound findings performed in the early and late postoperative periods, and final outcomes were collected. RESULTS Mean age of patients was 11.5 +/- 2.8 (range 6 to 15) years. Time interval between the onset of pain to surgery was 46.78 +/- 35.5 (range 12 to 126) hours. Seven patients had a benign solitary cyst as an underlying cause for adnexal torsion. The intervention performed by open surgery in 9 and by laparoscopy in 5 patients included detorsion, simple cyst aspiration, unroofing and/or cystectomy in 7 patients with ovarian cysts, and oophoropexy in 9 of 14 patients. Follow-up ranged from 3 to 66 (mean 21.9 +/- 20.1) months. Thirteen patients resumed normal size and folliculogenesis, whereas in 1 patient, the involved ovary atrophied. No recurrence or contralateral adnexal torsion was observed on follow-up. CONCLUSIONS Conservative management with untwisting the ovary and pexing both retained detorsed and contralateral ovaries especially in idiopathic torsions should be considered in cases of ovarian torsion in children.
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Dedecker F, Graesslin O, Khider Y, Fortier D, Quereux C, Gabriel R. Torsion tubaire isolée chez une adolescente de 15 ans. À propos d’un cas. ACTA ACUST UNITED AC 2003; 31:1036-8. [PMID: 14680785 DOI: 10.1016/j.gyobfe.2003.10.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Isolated torsion of the Fallopian tube is an uncommon event. Surgery is often necessary to establish the diagnosis. This report focuses on a 15-year old female who presented with acute pelvic pain. Pelvic ultrasound showed an adnexal mass. The laparoscopy performed confirmed the diagnosis of isolated tubal torsion. Based on this experience as well as on other similar reported cases, characteristics of isolated torsion of the Fallopian tube are discussed. This pathology should be considered in the differential diagnosis of acute pelvic pain in the female patient. Prompt surgical intervention may allow for preservation of the tube.
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Affiliation(s)
- F Dedecker
- Institut Mère-Enfant Alix-de-Champagne, centre hospitalier universitaire, 45, rue Cognacq-Jay, 51092 cedex, Reims, France
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40
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Descargues G, Tinlot-Mauger F, Gravier A, Lemoine JP, Marpeau L. Adnexal torsion: a report on forty-five cases. Eur J Obstet Gynecol Reprod Biol 2001; 98:91-6. [PMID: 11516806 DOI: 10.1016/s0301-2115(00)00555-8] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To evaluate the clinical findings, evolution of treatment and ovarian function following conservative therapy. STUDY DESIGN A case series of 45 patients presenting with adnexal torsion between January 1989 and June 1999. All patients were surgically treated, either conservatively or radically. Patients who had received conservative treatment, interviewed by phone and underwent ovarian sonographic examination. RESULTS Adnexal torsion is more frequent in young women with adnexal pathology. Conservative therapy by laparoscopy has gained increasing preference as a surgical procedure. It is safe and preserves ovarian function. CONCLUSIONS Conservative therapy by laparoscopy is recommended to preserve ovarian function in young women.
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Affiliation(s)
- G Descargues
- Clinique Gynécologique et Obstétricale, Pavillon Mère et Enfant, Hôpital Charles Nicolle, 1 rue de Germont, 76031 Cedex, Rouen, France.
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41
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Abstract
The authors report the clinical course of a young girl with ovarian torsion who was treated conservatively. This case shows that detorsion of the ovary may be associated with immediate postoperative febrile morbidity and slow resolution of ovarian enlargement. The authors emphasize that these signs can be associated with viable ovarian tissue and are not necessarily an indication for oophorectomy.
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Affiliation(s)
- C Templeman
- Department of Obstetrics and Gynecology, University of Louisville School of Medicine and Kosair Children's Hospital, Kentucky, USA
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Abstract
STUDY OBJECTIVE This study was undertaken to assess the indications, procedures, and pathology in premenarchal girls undergoing ovarian surgery. DESIGN Retrospective chart review. SETTING University of Michigan Medical Center 1980-1996. PARTICIPANTS Premenarchal girls, who underwent ovarian surgery. INTERVENTIONS None. MAIN OUTCOME MEASURES All available charts (n = 52) had information extracted concerning age at time of surgery, presenting symptoms, preoperative and postoperative diagnosis, procedure, and pathology report. RESULTS Of the 52 patients, 50% were less than 1 year old, 31% were between 1 and 8 years old, and 19% were between 8 and 12 years old. Presenting complaints in 31 patients included structural and or endocrinologic abnormalities, and the other 21 patients presented with abdominal or systemic complaints. The most common preoperative diagnosis was an abdominal/pelvic mass (n = 24). The postoperative diagnoses revealed 18 torsions and 16 ovarian masses without torsion, 8 chromosomal abnormalities, 5 hernias, and 5 malignancies. Procedures included 37 salpingo-oophorectomies (28 unilateral and 9 bilateral), 7 oophorectomies, and 7 cystectomies. One patient underwent a staging procedure. Pathology reports confirmed hemorrhagic infarctions (n = 19), dysgenic gonads (n = 8), simple cysts (n = 7), teratomas (n = 6), theca lutein cysts (n = 4), fibroma (n = 1), stromal tumor (n = 1), mucinous cystadenoma (n = 1), granulosa cell tumor (n = 1), uterine neuroblastoma (n = 1), mixed germ cell neoplasm (n = 1), metastatic Wilms' tumor (n = 1), and gonadoblastoma (n = 1). CONCLUSIONS Torsion was the most common diagnosis in our study group and was usually unsuspected. Premenarchal ovarian surgery usually included removal of the entire ovary. However, because malignancies are uncommon in this population (9.6%), a cystectomy should be considered when appropriate and technically feasible.
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Affiliation(s)
- E H Quint
- University of Michigan Health System, Department of Obstetrics and Gynecology, Ann Arbor 48109-0276, USA
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Abstract
The surgeon should be aware of the extensive applications of endoscopic surgery in the pediatric patient. The ability to provide surgical care in association with either outpatient or short-stay hospitalizations appear to be cost-effective and appropriate state-of-the-art medical care. Because the array of surgical instruments continues to evolve, new and innovative endoscopic procedures will continue to become increasingly available.
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Affiliation(s)
- T E Lobe
- Section of Pediatric Surgery, University of Tennessee, Memphis, USA
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