(69) Interval ovarian cystectomy in adnexal torsion cases, when?

Background: Adnexal torsion (AT) requires timely intervention to preserve ovarian functions. A concurrent adnexal pathology is also present in up to 80% of cases. Although detorsion with a minimally invasive surgery while preserving adnexal structures is the recommended approach, available data on the management of adnexal pathologies at the time of detorsion is limited. We aim to evaluate the relationship between the timing of interval ovarian cystectomy (IC) and occurrence of recurrent torsion in patients with ovarian cyst at the time of torsion and had detorsion alone

Methods: We retrospectively reviewed the records of the patients aged under 25 and underwent surgery for suspected AT at a tertiary PAG Service, between 2017 and 2023. Data on age, diagnostic studies, surgical procedure, intraoperative findings, postoperative folow-up and pathological findings were analyzed. We analyzed the recurrence rates of torsion between the patients who had an ovarian cyst and underwent cystectomy at the time of the detorsion (Group 1) and who underwent detorsion alone (Group 2). Timing of IOC and time to recurrent torsion were evaluated in Group 2

Results: Among a total of 74 cases identified, AT was surgically confirmed in 55 patients (%74). The mean age of the patients was 17.8±4.3 . All but one patient underwent laparoscopy with ovarian preservation in 53 (96%) of the cases. A cyst was present in 60% (n=33) of these patients and a cystectomy was performed at the time of detorsion in 57% of the cases (Table 1). IOC was performed in 7 of 10 patients who underwent detorsion alone and the median interval between the initial and the second surgery was 9 weeks. One of theese 10 patients, who underwent detorsion alone, oophorectomy is required in 1 patient due to the presence of necrotic ovarian tissue found at the time of IOC. While recurrent torsion was observed in 1 patient in Group 1 (9 months after the surgery), recurrent torsion developed in 4 patients during the IOC planning in Group 2 (P=0.02). For these 4 patients in Group 2, the median interval for the development of recurrent torsion was 12 weeks (range 4-20 weeks), and 3 of these 4 patients were found to have a dermoid cyst and 1 cystadenoma

Conclusions: It seems reasonable to perform cystectomy at the time of detorsion in order to reduce the risk of recurrent torsion. In cases where the ovary is severely edematous and fragile, cystectomy may lead to further ovarian damage and oophorectomy. Our findings suggest that in these cases where scheduled IOC is required, keeping the time between two surgeries as short as 3-4 weeks may reduce the development of recurrent torsion, especially in the presence of cysts known to persist such as mature teratoma