Emily C Alberto1, Jun Tashiro1, Yinan Zheng1, Anthony Sandler1, Timothy Kane1, Veronica Gomez-Lobo2,3, Mikael Petrosyan4. 1. Department of Surgery, Children's National Hospital, 111 Michigan Ave NW, Washington DC, 20010, USA. 2. Departement of Surgery/Pediatric Gynecology, Children's National Hospital, Washington DC, USA. 3. Pediatric and Adolescent Gynecology, Eunice Kennedy Shriver Institute for Child Health and Human Development, Bethesda, MD, USA. 4. Department of Surgery, Children's National Hospital, 111 Michigan Ave NW, Washington DC, 20010, USA. mpetrosy@childrensnational.org.
Abstract
PURPOSE: Adnexal torsion is a gynecologic emergency, requiring intervention for tissue preservation. At our institution, torsion is managed by pediatric surgeons or gynecologists. We evaluated differences between specialties to streamline evaluation for children with gynecological emergencies, develop a clinical pathway, and prevent care delays. METHODS: A retrospective review of adolescents undergoing intervention for adnexal torsion from 2004-2018 was performed. Differences in time to intervention, operation duration, the procedure performed, and length of stay (LOS) between the specialties were analyzed. RESULTS: Eighty-six patients underwent 94 operations for presumed adnexal torsion with 87 positive cases. Pediatric surgeons performed 60 operations and 34 cases were performed by gynecologists. Preservation of fertility was the goal in both cohorts and the rate of oophoropexy, cystectomy, and oophorectomy were similar between the cohorts (p = 0.14, p = 1.0, p = 0.39, respectively). There was no difference in intra-operative time (p = 0.69). LOS was shorter in the gynecology cohort (median 1 day [1-2] vs. 2 days [2-3], p > 0.001). CONCLUSIONS: Adnexal torsion is a time-sensitive diagnosis requiring prompt intervention for ovarian or fallopian tube preservation. A multidisciplinary institutional care pathway should be developed and implemented.
PURPOSE: Adnexal torsion is a gynecologic emergency, requiring intervention for tissue preservation. At our institution, torsion is managed by pediatric surgeons or gynecologists. We evaluated differences between specialties to streamline evaluation for children with gynecological emergencies, develop a clinical pathway, and prevent care delays. METHODS: A retrospective review of adolescents undergoing intervention for adnexal torsion from 2004-2018 was performed. Differences in time to intervention, operation duration, the procedure performed, and length of stay (LOS) between the specialties were analyzed. RESULTS: Eighty-six patients underwent 94 operations for presumed adnexal torsion with 87 positive cases. Pediatric surgeons performed 60 operations and 34 cases were performed by gynecologists. Preservation of fertility was the goal in both cohorts and the rate of oophoropexy, cystectomy, and oophorectomy were similar between the cohorts (p = 0.14, p = 1.0, p = 0.39, respectively). There was no difference in intra-operative time (p = 0.69). LOS was shorter in the gynecology cohort (median 1 day [1-2] vs. 2 days [2-3], p > 0.001). CONCLUSIONS: Adnexal torsion is a time-sensitive diagnosis requiring prompt intervention for ovarian or fallopian tube preservation. A multidisciplinary institutional care pathway should be developed and implemented.
Entities:
Keywords:
Adnexal disease; Adolescent; General surgery; Gynecology; Ovarian torsion
Authors: James M Prieto; Karen M Kling; Romeo C Ignacio; Stephen W Bickler; Timothy J Fairbanks; Nicholas C Saenz; Sneha I Nicholson; David A Lazar Journal: J Pediatr Surg Date: 2019-08-30 Impact factor: 2.545