(96) Ovarian Torsion After Oophoropexy: A Retrospective Review Through the NASPAG Fellows Research Consortium

Background: Pediatric ovarian torsion (OT) is rare and occurs more frequently in premenarchal girls, presumably due to prepubertal adnexal anatomy. There is little literature examining the rate of recurrent OT after oophoropexy (OP), though this operation is commonly performed to prevent OT and preserve the gonad. We sought to determine the rate of OT after OP (by plication or fixation) in a pediatric population to determine the success of OP for preventing recurrent OT.

Methods: This is a multisite IRB-approved retrospective cohort from four institutions through the NASPAG Fellows Research Consortium. Charts were reviewed between January 1, 2009 and June 30, 2020 of patients aged 18 years or less who had experienced two or more surgically confirmed OT events and/or one or more OP. The number of single OT events for this age group at each site was collected to calculate the baseline recurrent OT rate. All operative events for each patient were recorded including surgery type. Other variables collected included age, menarchal status, and whether OP was performed by plication of the utero-ovarian ligament or by adnexal fixation to another structure. Variables were recorded separately for each operative event into a single REDCap database. Those who had OP for transposition prior to radiation, isolated fallopian tube torsion, or a suspected OT that was not surgically documented were excluded.

Results: 539 patients had 591 surgically documented OT events; 117 qualified for the study. The mean age at first OT for all study subjects was 10.17 years. 13 patients (9/13 pre-menarchal, 2 post-, 2 unknown) had OT after OP; with an OT recurrence rate of 13.8%, significantly higher (p=.03) than the 7.9% OT recurrence rate for those who did not have a previous OP. These 13 patients underwent a total of 26 OP, (6/26 bilateral); 17 (65%) fixations and 7 (27%) plications, with an average of 2.78 OT events (range 2-5) and 1.92 OP procedures (range 1-3) per patient. For the 81 patients who had an OP and did not have a subsequent OT, 82 total OP were performed (15/82 bilateral); 57 (69%) fixations and 25 (30%) plications; only 1/81 had more than one OP.

Conclusions: In this cohort, most of those with recurrent OT also had multiple OP, and OT was surprisingly more likely to occur if an OP had been done. Fixation and plication rates were similar for those who did and did not have recurrent OT after OP. Although data is limited to retrospective review, we report a large number of cases, and suggest that some patients are at high risk for recurrent OT, and OP (regardless of technique) likely does not offer meaningful protection against OT recurrence.