Page 34 - World Journal of Laparoscopic Surgery

REVIEW ARTICLE
Antenatally Diagnosed Ovarian Cysts with Torsion Managed

Laparoscopically

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Sujitha Sivarajan , Rajineesh K Mishra , Jatinder Singh Chowhan 3
AbstrAct
Aim and objective: To study the various types of laparoscopic management of antenatal ovarian torsion, their advantages, disadvantages, and
its outcome in pregnancy.
Background: Ovarian torsion in pregnancy occurs at a rate of about 1 in 5,000 cases. It is a life-threatening condition if not attended to and
intervened promptly. Recent years have seen the advent of laparoscopy as a preferred means of management for ovarian torsion in pregnancy.
This review article analyzes a series of articles over a span of 5 years from 2014 to 2018 on laparoscopic management of ovarian torsion in
pregnancy and its outcome.
Results: Various procedures like ovarian detorsion, cystectomy, ovarian cyst puncture, ovariopexy, shortening of the utero-ovarian ligament,
and oophorectomy are performed by expert hands. While advantages include quick recovery and early discharge from hospital, disadvantages
are a long learning curve and increased need for training. This has led to many uneventful pregnancies with term live births.
Conclusion: Each type of laparoscopic management for antenatal ovarian torsion has its pros and cons. Nevertheless, the outcome of the
pregnancy has been excellent in the majority of the laparoscopically managed cases.
Clinical significance: Laparoscopic management of antenatal ovarian torsion has reduced intraoperative blood loss, improved postoperative
pain, and led to a quick recovery, early discharge from hospital, and return to daily activities. Clinicians need to be adequately trained to be
competent in performing various laparoscopic surgeries.
Keywords: Antenatal ovarian torsion, Laparoscopic ovarian detorsion, Utero-ovarian ligament.
World Journal of Laparoscopic Surgery (2020): 10.5005/jp-journals-10033-1417

bAckground 1 Department of Obstetrics and Gynaecology, Vijaya Hospital, Chennai,

Ovarian torsion is a common gynecological emergency. It is found to Tamil Nadu, India
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be the fifth most common gynecological surgical emergency. This 2,3 Department of Minimal Access Surgery, World Laparoscopy Hospital,
involves the twisting of the ovary in its pedicle, leading to ovarian New Delhi, India
infarction if it is not unwounded in time. Prompt identification and Corresponding Author: Sujitha Sivarajan, Department of Obstetrics
intervention are crucial in the management of ovarian torsion. and Gynaecology, Vijaya Hospital, Chennai, Tamil Nadu, India, Phone:
Nevertheless, the clinical presentation can present as a diagnostic +91 9600563014, e-mail: sujifudge@hotmail.com
challenge for clinicians. Studies have shown 23–66% of cases were How to cite this article: Sivarajan S, Mishra RK, Chowhan JS. Antenatally
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given accurate presurgical diagnosis. Transvaginal ultrasound is Diagnosed Ovarian Cysts with Torsion Managed Laparoscopically.
the most widely used imaging modality to confirm clinical findings World J Lap Surg 2020;13(3):133–135.
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though it can be inconclusive at times. Laparoscopy has enhanced Source of support: Nil

the efficacy of management of ovarian torsion in pregnancy with Conflict of interest: None
advantages like less pain, speedy recovery, and shorter hospital
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stays with an uneventful pregnancy.
Management of ovarian torsion during pregnancy aims
results at saving not only the ovary but also the current and future
pregnancies. Early intervention helps to possibly retain blood
This review article analyzes a few articles related to laparoscopic supply to the ovary and thereby avoiding oophorectomy due to
management of ovarian torsion in pregnancy over 5 years between gangrenous changes. Unwinding the torted utero-ovarian ligament
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2014 and 2018 to study its efficacy and its outcome in pregnancy. It re-establishes the blood supply. Oelsner et al. did a retrospective
includes retrospective case–control study, single-center study, and analysis of 102 patients managed with surgical interventions for
case reports that were selected manually from PubMed online. The adnexal torsion. They reported that 91.3% of patients with bluish-
results of the analysis of the selected articles are explained below black ovary regained normal function following detorsion. None
with regards to various laparoscopic techniques in the management of the patients developed pelvic or systemic thromboembolism
of ovarian torsion which ranges from ovarian detorsion, cystectomy, which is a risk presumed to occur following detorsion of the adnexa.
ovarian cyst puncture, ovariopexy, oophoropexy, shortening of the At times, cystectomy is required in the case of a simple ovarian
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utero-ovarian ligament and oophorectomy, their advantages and cyst or dermoid cyst. Ding et al. had suggested removal of
disadvantages, and finally the outcome of pregnancy following the dermoid cyst in an endobag to avoid spillage into the abdominal
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minimally invasive procedure. cavity through laparoendoscopic single-site surgery (LESS).
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