Roshni Dasgupta1, Elizabeth Renaud2, Adam B Goldin3, Robert Baird4, Danielle B Cameron5, Meghan A Arnold6, Karen A Diefenbach7, Ankush Gosain8, Julia Grabowski9, Yigit S Guner10, Tim Jancelewicz8, Akemi Kawaguchi11, Dave R Lal12, Tolulope A Oyetunji13, Robert L Ricca14, Julia Shelton15, Stig Somme16, Regan F Williams8, Cynthia D Downard17. 1. Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Medical Center, Cincinnati, OH. Electronic address: Roshni.dasgupta@cchmc.org. 2. Department of Surgery, Division of Pediatric Surgery Albany Medical College, Albany, NY. 3. Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA. 4. Division of Pediatric General and Thoracic Surgery, Montreal Children's Hospital, Montreal, QC. 5. Department of Surgery, Boston Children's Hospital, Boston, MA. 6. Section of Pediatric Surgery, CS Mott Children's Hospital, Ann Arbor, MI. 7. Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH. 8. Division of Pediatric Surgery, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, TN. 9. Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL. 10. Division of Pediatric General and Thoracic Surgery Children's Hospital Orange County, University of California Irvine. 11. Department of Pediatric Surgery, Mc Govern Medical School at the University of Texas Health Science Center at Houston. 12. Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI. 13. Department of Surgery, Children's Mercy Hospital, Kansas City, MO. 14. Division of Pediatric Surgery, Naval Medical Center, Portsmouth, VA. 15. Division of Pediatric Surgery, University of Iowa Stead Family Children's Hospital, Iowa City, IA. 16. Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado, Aurora, Colorado. 17. Division of Pediatric Surgery, Hiram C. Polk, Jr, MD Department of Surgery, University of Louisville, Louisville, KY.
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.
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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