Ovarian torsion post laparoscopic hysterectomy.

Abstract

Background/aim: Adnexal torsion is a common gynaecological emergency in which the adnexa twists on its supportive ligaments leading to disruption of its blood supply and, ultimately necrosis if not promptly treated. Unfortunately, diagnosis can be challenging due to its non-specific presentation. Large ovarian size and ovarian cysts are well accepted risks factors. Hysterectomy was not considered a risk factor until 2004, when Mashiach et al. found 7 cases of adnexal torsion post laparoscopic hysterectomy suggesting a possible link. Its mechanism is not fully understood yet. The literature shows that compared to other hysterectomy approaches, the laparoscopic one creates less adhesions. Consequently, it has be theorised that with minimal adhesions, the ovaries are more mobile, increasing the likelihood of torsion. The literature on adnexal torsion post laparoscopic hysterectomy is still limited. In addition to Mashiach et al., only two studies, namely a retrospective cohort study and a nested case-control study with 8 and 46 cases of torsions respectively, found laparoscopic hysterectomy to be a risk factor for adnexal torsion. The rest of the publications are case reports. Our study aims to assess whether there really is a link between laparoscopic hysterectomy and ovarian torsion. Population/setting: A single regional, Victorian, Australian clinic, with records of ovarian torsion diagnosed at laparoscopy after a previous laparoscopic hysterectomy across 20 years. Methods: Retrospective cohort study evaluating the number of ovarian torsions after laparoscopic hysterectomy from existing database. Results/findings: The prevalence of ovarian torsion in our study population was 0.63% (18/2874). Conclusion: Our study showed that women were significantly more likely (p<0.05) to experience ovarian torsion after a laparoscopic hysterectomy as compared to the population risk and to all other types of hysterectomy. Translational impact/implications for future practice: Our study provides further support for an association between ovarian torsion and a laparoscopic approach to hysterectomy. Further prospective studies should be undertaken, and consideration given for the role of prophylactic ovarian fixation at the time of hysterectomy