Journal article
Ovarian torsion in pediatric and adolescent patients: A systematic review
Journal of pediatric surgery, Vol.53(7), pp.1387-1391
07/2018
DOI: 10.1016/j.jpedsurg.2017.10.053
PMID: 29153467
Abstract
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.
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.
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.
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.
Systematic review of level 3–4 studies.
3–4
Details
- Title: Subtitle
- Ovarian torsion in pediatric and adolescent patients: A systematic review
- Creators
- Roshni Dasgupta - Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Medical Center, Cincinnati, OHElizabeth Renaud - Department of Surgery, Division of Pediatric Surgery Albany Medical College, Albany, NYAdam B Goldin - Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WARobert Baird - Division of Pediatric General and Thoracic Surgery, Montreal Children's Hospital, Montreal, QCDanielle B Cameron - Department of Surgery, Boston Children's Hospital, Boston, MAMeghan A Arnold - Section of Pediatric Surgery, CS Mott Children's Hospital, Ann Arbor, MIKaren A Diefenbach - Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OHAnkush Gosain - Division of Pediatric Surgery, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, TNJulia Grabowski - Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, ILYigit S Guner - Division of Pediatric General and Thoracic Surgery Children's Hospital Orange County, University of California IrvineTim Jancelewicz - Division of Pediatric Surgery, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, TNAkemi Kawaguchi - Department of Pediatric Surgery, Mc Govern Medical School at the University of Texas Health Science Center at HoustonDave R Lal - Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WITolulope A Oyetunji - Department of Surgery, Children's Mercy Hospital, Kansas City, MORobert L Ricca - Division of Pediatric Surgery, Naval Medical Center, Portsmouth, VAJulia Shelton - Division of Pediatric Surgery, University of Iowa Stead Family Children's Hospital, Iowa City, IAStig Somme - Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado, Aurora, ColoradoRegan F Williams - Division of Pediatric Surgery, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, TNCynthia D Downard - Division of Pediatric Surgery, Hiram C. Polk, Jr, MD Department of Surgery, University of Louisville, Louisville, KY
- Resource Type
- Journal article
- Publication Details
- Journal of pediatric surgery, Vol.53(7), pp.1387-1391
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.jpedsurg.2017.10.053
- PMID
- 29153467
- ISSN
- 0022-3468
- eISSN
- 1531-5037
- Language
- English
- Date published
- 07/2018
- Academic Unit
- Stead Family Department of Pediatrics; Surgery
- Record Identifier
- 9984051586802771
Metrics
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