Nurşen KURTOĞLU AKSOYa , Evrim Ebru KOVALAKa , Mevlide ŞAN KARAMANa aDepartment of Obstetrics and Gynecology, University of Health Sciences Bağcılar Training and Research Hospital, İstanbul, Türkiye
ABSTRACT Objective: Adnexal torsion is one of the gynecological surgical emergencies that can be seen in women of all ages, with or without an ovarian cyst. In this study, it was aimed to investigate the effect of performing cystectomy on ovarian reserve in an ovary exposed to ischemia during emergency surgery in cases of adnexal torsion with an ovarian cyst, which is presumed to be benign. Material and Methods: The ovaries of nineteen women who underwent laparoscopic detorsion due to adnexal torsion (Group 1) and the ovaries of ten women who underwent laparoscopic detorsion+cystectomy in the same session with adnexal torsion due to a cyst, which was presumed to be benign (Group 2) were compared in terms of ovarian volume and antral follicular counts (AFC). Results: There was no statistically significant difference between the volumes and AFCs of the operated ovaries of the women in Group 1 (ovarian volume 11.56±9.58 cm3, AFC: 8.52±5.92 cm3) and the women in Group 2 (ovarian volume 10.99±5.07 cm3, AFC: 9.20±3.15 cm3) (p>0.05). Conclusion: Performing a cystectomy during detorsion surgery for a cyst presumed to be benign in a torsioned ovary exposed to ischemia does not seem to do any additional harm when evaluated in terms of AFC and volume.
Garde I, Paredes C, Ventura L, Pascual MA, Ajossa S, Guerriero S, et al. Diagnostic accuracy of ultrasound signs for detecting adnexal torsion: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2023;61(3):310-24. [Crossref][PubMed]
Takeda A, Hayashi S, Teranishi Y, Imoto S, Nakamura H. Chronic adnexal torsion: an under-recognized disease entity. Eur J Obstet Gynecol Reprod Biol. 2017;210:45-53. [Crossref][PubMed]
Huang C, Hong MK, Ding DC. A review of ovary torsion. Ci Ji Yi Xue Za Zhi. 2017;29(3):143-7. [Crossref][PubMed][PMC]
Chang-Patel EJ, Palacios-Helgeson LK, Gould CH. Adnexal torsion: a review of diagnosis and management strategies. Curr Opin Obstet Gynecol. 2022;34(4):196-203. [Crossref][PubMed]
Karadağ C, Demircan S, Turgut A, Çalışkan E. Effects of laparoscopic cystectomy on ovarian reserve in patients with endometrioma and dermoid cyst. Turk J Obstet Gynecol. 2020;17(1):15-20. [Crossref][PubMed][PMC]
Salihoğlu KN, Dilbaz B, Cırık DA, Ozelci R, Ozkaya E, Mollamahmutoğlu L. Short-term impact of laparoscopic cystectomy on ovarian reserve tests in bilateral and unilateral endometriotic and nonendometriotic cysts. J Minim Invasive Gynecol. 2016;23(5):719-25. [Crossref][PubMed]
Baracat CMF, Abdalla-Ribeiro HSA, Araujo RSDC, Bernando WM, Ribeiro PA. The impact on ovarian reserve of different hemostasis methods in laparoscopic cystectomy: a systematic review and meta-analysis. Rev Bras Ginecol Obstet. 2019;41(6):400-8. [Crossref][PubMed][PMC]
Smolinski SE, Kreychman A, Catanzano T. Ovarian torsion: multimodality review of imaging characteristics. J Comput Assist Tomogr. 2015;39(6):922-4. [Crossref][PubMed]
Wu MY, Yiang GT, Liao WT, Tsai AP, Cheng YL, Cheng PW, et al. Current mechanistic concepts in ischemia and reperfusion injury. Cell Physiol Biochem. 2018;46(4):1650-67. [Crossref][PubMed]
Ozler A, Turgut A, Soydinç HE, Sak ME, Evsen MS, Alabalik U, et al. The biochemical and histologic effects of adnexal torsion and early surgical intervention to unwind detorsion on ovarian reserve: an experimental study. Reprod Sci. 2013;20(11):1349-55. [Crossref][PubMed]
Tokgoz VY, Sipahi M, Keskin O, Guvendi GF, Takir S. Protective effects of vitamin D on ischemia-reperfusion injury of the ovary in a rat model. Iran J Basic Med Sci. 2018;21(6):593-9. [PubMed][PMC]
Bhardwaj JK, Paliwal A, Saraf P, Sachdeva SN. Role of autophagy in follicular development and maintenance of primordial follicular pool in the ovary. J Cell Physiol. 2022;237(2):1157-70. [Crossref][PubMed]
Sinha S, Sharan A, Sinha S. Anti-Mullerian hormone as a marker of ovarian reserve and function. Cureus. 2022;14(9):e29214. [Crossref][PubMed][PMC]
Kesharwani DK, Mohammad S, Acharya N, Joshi KS. Fertility with early reduction of ovarian reserve. Cureus. 2022;14(10):e30326. [Crossref][PubMed][PMC]
Bozdag G, Demir B, Calis PT, Zengin D, Dilbaz B. The impact of adnexal torsion on antral follicle count when compared with contralateral ovary. J Minim Invasive Gynecol. 2014;21(4):632-5. [Crossref][PubMed]
Sireesha MU, Chitra T, Subbaiah M, Nandeesha H. Effect of laparoscopic ovarian cystectomy on ovarian reserve in benign ovarian cysts. J Hum Reprod Sci. 2021;14(1):56-60. [Crossref][PubMed][PMC]
Becker CM, Bokor A, Heikinheimo O, Horne A, Jansen F, Kiesel L, et al; ESHRE Endometriosis Guideline Group. ESHRE guideline: endometriosis. Hum Reprod Open. 2022;2022(2):hoac009. [PubMed][PMC]
Raffi F, Metwally M, Amer S. The impact of excision of ovarian endometrioma on ovarian reserve: a systematic review and meta-analysis. J Clin Endocrinol Metab. 2012;97(9):3146-54. [Crossref][PubMed]
Somigliana E, Berlanda N, Benaglia L, Viganò P, Vercellini P, Fedele L. Surgical excision of endometriomas and ovarian reserve: a systematic review on serum antimüllerian hormone level modifications. Fertil Steril. 2012;98(6):1531-8. [Crossref][PubMed]
Tan Z, Gong X, Li Y, Hung SW, Huang J, Wang CC, et al. Impacts of endometrioma on ovarian aging from basic science to clinical management. Front Endocrinol (Lausanne). 2023;13:1073261. [Crossref][PubMed][PMC]
Jang WK, Lim SY, Park JC, Lee KR, Lee A, Rhee JH. Surgical impact on serum anti-Müllerian hormone in women with benign ovarian cyst: a prospective study. Obstet Gynecol Sci. 2014;57(2):121-7. [Crossref][PubMed][PMC]
Amooee S, Gharib M, Ravanfar P. Comparison of anti-mullerian hormone level in non-endometriotic benign ovarian cyst before and after laparoscopic cystectomy. Iran J Reprod Med. 2015;13(3):149-54. [PubMed][PMC]
Ergun B, Ozsurmeli M, Dundar O, Comba C, Kuru O, Bodur S. Changes in markers of ovarian reserve after laparoscopic ovarian cystectomy. J Minim Invasive Gynecol. 2015;22(6):997-1003. [Crossref][PubMed]
Muzii L, Di Tucci C, Di Feliciantonio M, Marchetti C, Perniola G, Panici PB. The effect of surgery for endometrioma on ovarian reserve evaluated by antral follicle count: a systematic review and meta-analysis. Hum Reprod. 2014;29(10):2190-8. [Crossref][PubMed]
Chang HJ, Han SH, Lee JR, Jee BC, Lee BI, Suh CS, et al. Impact of laparoscopic cystectomy on ovarian reserve: serial changes of serum anti-Müllerian hormone levels. Fertil Steril. 2010;94(1):343-9. [Crossref][PubMed]
Templeman CL, Fallat ME, Lam AM, Perlman SE, Hertweck SP, O'Connor DM. Managing mature cystic teratomas of the ovary. Obstet Gynecol Surv. 2000;55(12):738-45. [Crossref][PubMed]
Muzii L, Luciano AA, Zupi E, Panici PB. Effect of surgery for endometrioma on ovarian function: a different point of view. J Minim Invasive Gynecol. 2014;21(4):531-3. [Crossref][PubMed]
Li H, Yan B, Wang Y, Shu Z, Li P, Liu Y, et al. The optimal time of ovarian reserve recovery after laparoscopic unilateral ovarian non-endometriotic cystectomy. Front Endocrinol (Lausanne). 2021;12:671225. [Crossref][PubMed][PMC]
Exacoustos C, Zupi E, Amadio A, Szabolcs B, De Vivo B, Marconi D, et al. Laparoscopic removal of endometriomas: sonographic evaluation of residual functioning ovarian tissue. Am J Obstet Gynecol. 2004;191(1):68-72. [Crossref][PubMed]
Hendriks DJ, Kwee J, Mol BW, te Velde ER, Broekmans FJ. Ultrasonography as a tool for the prediction of outcome in IVF patients: a comparative meta-analysis of ovarian volume and antral follicle count. Fertil Steril. 2007;87(4):764-75. [Crossref][PubMed]
Tsafrir Z, Hasson J, Levin I, Solomon E, Lessing JB, Azem F. Adnexal torsion: cystectomy and ovarian fixation are equally important in preventing recurrence. Eur J Obstet Gynecol Reprod Biol. 2012;162(2):203-5. [Crossref][PubMed]
Upadhyay A, Stanten S, Kazantsev G, Horoupian R, Stanten A. Laparoscopic management of a nonobstetric emergency in the third trimester of pregnancy. Surg Endosc. 2007;21(8):1344-8. [Crossref][PubMed]
Casey RK, Damle LF, Gomez-Lobo V. Isolated fallopian tube torsion in pediatric and adolescent females: a retrospective review of 15 cases at a single institution. J Pediatr Adolesc Gynecol. 2013;26(3):189-92. [Crossref][PubMed]
Huchon C, Fauconnier A. Adnexal torsion: a literature review. Eur J Obstet Gynecol Reprod Biol. 2010;150(1):8-12. [Crossref][PubMed]