Contemporary Trends in Laparoscopy and Ovarian Sparing Surgery for Ovarian Torsion in the Pediatric Population
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New article you should know about by Kim Priban
"Contemporary Trends in Laparoscopy and Ovarian Sparing Surgery for Ovarian Torsion in the Pediatric Population"
Authors: Carlos Theodore Huerta 1Cindy Rodriguez, Joshua Parreco, Chad M. Thorson, Juan E. Sola, Eduardo A. Perez
Full Article can be found at https://doi.org/10.1016/j.jpedsurg.2023.10.042
Purpose
Although total oophorectomy (TO) was historically performed in cases of nonviable-appearing ovaries, considerable evidence has demonstrated equivalent outcomes after ovarian sparing surgery (OSS) as well as long-term fertility preservation benefits. This study sought to compare outcomes of OSS and TO for patients with ovarian torsion.
Methods
Females <21 years old admitted for ovarian torsion were identified from the Nationwide Readmissions Database (2016–2018) and stratified by OSS or TO. Propensity score-matched analysis (PSMA) utilizing >50 covariates (demographics, medical comorbidities, ovarian diagnoses, etc.) was constructed between those receiving TO and OSS.
Results
There were 3,161 females (median 15 [12–18] years) with ovarian torsion, and concomitant pathologies included cysts (42%), benign masses (25%), and malignant masses (<1%). Open approaches were more common (52% vs. 48% laparoscopic), and ovarian resection (OSS or TO) was performed in 87% (39% OSS and 48% TO). OSS was more commonly performed with laparoscopic detorsions (60% vs. 40% TO), while TO was more frequent in open operations (59% vs. 41% TO; both p < 0.001). No differences in overall readmissions (7% OSS vs. 8% TO) or readmissions for recurrent torsion (<1% overall) and ovarian masses (<1%) were observed (both groups <1%; p = 0.612). After PSMA, laparoscopy was still utilized less frequently with TO (39% vs. 53%; p < 0.001) despite similar rates of malignant masses.
Conclusions
Overall, these data offer additional support for the current practice guidelines that give preference to OSS as the primary method of treatment for pediatric ovarian torsion in the majority of cases.
Level of Evidence
III.
Type of Study
Retrospective Comparative Study.
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Transcript
Should a laparoscopic ovarian sparing surgery be favored instead of a total oophorectomy in a young patient with an ovarian torsion? Hi, I'm Kim Priven, a research fellow at Cincinnati Children's, and I think this is an article you should know about. This article out of the University of Miami Miller School of Medicine and Florida State University School of Medicine is one of the largest retrospective studies comparing overall readmission, retorsion, and ovarian tumor status in patients who either had a. oophorectomy or an ovarian sparing surgery for a torsion. And what did they find? 3,161 girls between the ages of 12 and 18 were reviewed for the type of surgical approach utilized to address an ovarian torsion. The results showed that there was no significant difference between the surgical approaches and that the open total oophorectomies were the most common procedure utilized. And also, laparoscopic ovary sparing procedures were underutilized. This is really interesting because the current evidence-based guidelines from the American Pediatric Surgical Association recommends detortion with ovary sparing surgery due to its potential for long-term fertility benefits. This study definitely demonstrates that there is an opportunity for increased education and quality improvement initiatives for patients with ovarian torsion. Thank you for watching, like and share, and as always, let us know what you think. Stay tuned for more articles we think you should know about.