Ovarian Torsion with Dr. Dasgupta

Ovarian torsion is one of those pathologies that straddles both general surgery and gynecologic surgery providers. But in pediatric surgery, often ovarian torsion really falls into our wheelhouse. And so today, we're going to review up-to-date best practices with an expert. And as general surgeons, we do not do a good job in ovarian preservation, so it's something that we really need to think about. Um, our gynecology colleagues do a much better job, um, and we are seeing we're we're seeing a change in that our practice, but it's, um, still not good in terms of how many ovaries that general surgery takes out compared to, um, gynecology. That's Dr. Roshni Dasgupta, a pediatric surgeon at Cincinnati Children's Hospital Medical Center, and today she's going to teach us all about the workup and the management of ovarian pathology in the pediatric patient. So stick around. This is the stay current podcast. In a patient with ovarian torsion, well, there's a lot to consider. First, we have to figure out the diagnosis and that's not always clear. Then second, once you make it to the operating room, there's a lot of variation about what you should do. surgeons in general that, um, we again don't do a good job in terms of keeping ovaries. The rate of oophorectomies, um, was pretty significant on patients that had ovarian torsion. Um, about 15% of them only underwent detorsion in the in the a series that looked at 2,041 patients of from the from 2000 to 2014. Um, and many of them vast majority, 80% almost had a oophorectomy. If you're listening in the stay current app, we've got the full article linked below. So check it out. Oophorectomy were higher in non-teaching hospitals, younger patients and in the south, and some of the rural disparities that we were talking about. Um, but even recent data as of um last year show that still one quarter of patients who have ovarian torsion are still getting oophorectomies despite all this evidence that you shouldn't do it. Uh and again, it's pediatric surgeons versus gynecologist that are doing all these oophorectomies. So in a patient with ovarian torsion, what should we be doing intraoperatively? So untwist and take a look and see if it would pink up. Now, that's all well and good for an ovary that pinks up and starts looking viable in the operating room. But what about the ovary that looks black after you've waited five minutes? And then even after you've waited 10 minutes, or even longer. Do you want to leave that alone? So even if they are if they pinks up, great, but even if it's black, like that picture right there, you should leave it alone. I trust you, Dr. Dasgupta, but it just doesn't feel good to leave nonviable looking tissue inside a patient. So what makes this an acceptable approach? Ovarian ovaries have dual blood supply, they do pink up and almost all of them are salvageable. So, um, you definitely do not want to take them out. Um, there's really no if you are worried that there is a mass there, you want to do that three week ultrasound and see if there is a mass there and then you can go back in. But you really do not want to mess up mess around with a torsed ovary, you just want to untwist it, leave it alone and come back another day. Well, I can definitely see how general surgeons may take out more ovaries than needed. Sometimes ovaries that look like this, just pink up and look normal and and actually have excellent function. You know that by taking out an ovary, you increase this um menopause by seven years. So you have menopause seven years earlier and you can um affect fertility rate. So it's really important to try and preserve the ovaries if you can. Is there anything else I should be doing in the operating room? I mean, besides detorsion, can ovarian pexy help decrease my chances of future torsion? There's been a Cocrin review, um, that is really showed that actually ovarian pexy can actually cause more problems. Um, and that it's probably not indicated, um, unless you see a really, really sort of spread out broad ligaments or some other reason for it to be, um to for it to tors. All right, all right, so just to review. A patient with ovarian torsion, well, they need an operation. So they go to the operating room and the ovary gets detorsed. If the child's not sick, then the ovary can be left in place, really regardless of the appearance. We make sure to inspect the ovary and note any concerning findings regarding a mass or anything else that we'd want to follow. And pexy, well, it's just not indicated in the majority of patients. But a follow-up ultrasound is, especially if there's concern for a mass. Overall, fertility preservation is a key component to proper management. Did I get all that right, Dr. Dasgupta? The gynecologist are much more likely to perform ovarian preservations than pediatric general surgeons. And um, you know, we just need to be very cognizant of um ovarian preservation and thinking about it at all um points and even in neoplastic tumors, ovarian torsion and things like that where you might be able to save the ovary. Thanks for joining our stay current short on ovarian torsion with Dr. Dasgupta. Remember, download the stay current app, check us out on YouTube and Facebook and Twitter, but until next time, I'm Brittany and remember, knowledge should be free.