Laparoscopic Excision of Ovarian Remnants: Retrospective Cohort Study with Long-term Follow-up

Arden D, D. Arden, Deborah Arden, Lee T, Ted Lee
Journal of Minimally Invasive Gynecology · 2011 · vol. 18(2) , pp. 194–199 · doi:10.1016/j.jmig.2010.12.002 · PMID:21295527 · W2008633614
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This retrospective study evaluated the long-term outcomes of laparoscopic excision for ovarian remnants, analyzing complication rates and patient satisfaction.

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Abstract

Study objectiveTo review the clinical presentation, surgical and pathologic findings, and long-term outcomes after excision of ovarian remnants using a predominantly laparoscopic approach.DesignRetrospective medical record review and long-term follow-up via telephone interview (Canadian Task Force classification II-3).SettingLarge academic medical institution.PatientsThirty women who underwent excision of pathologically confirmed ovarian remnants by a single surgeon between 2001 and 2009.InterventionExcision of ovarian remnants, 29 at laparoscopy and 1 at laparotomy.Measurements and main resultsOf the 30 patients, 29 had pain and 1 had a persistent adnexal mass. Of the 29 patients who underwent preoperative ultrasonography, 26 (89.6%) had an adnexal mass on the side of previous salpingo-oophorectomy. Masses ranged in size from 0.8 to 7.4 cm in greatest diameter and most commonly contained debris-filled cysts. Intraoperatively, 29 excisions (96.7%) required retroperitoneal dissection, 27 (90.0%) required enterolysis, 28 (93.3%) required ureterolysis, and 20 (66.7%) required ligation of the uterine artery at its origin. All pathology reports confirmed ovarian tissue, often associated with endometriosis, corpus luteal cysts, and simple cysts. Four bowel injuries and 2 bladder injuries were laparoscopically repaired by the primary surgeon. Three patients required bowel resections by a general surgeon. Records from postoperative visits were available for 28 patients, of whom 17 (60.7%) reported resolution of pain, 9 (32.1%) reported improvement, and 2 (7.1%) reported persistent pain. Of the 18 women who returned written consent for the telephone interview, 11 (61.1%) reported resolution of pain, 5 (27.8%) reported improvement, and 2 (11.1%) reported persistent pain.ConclusionWhile laparoscopic excision of ovarian remnants is feasible, the procedure almost always requires a retroperitoneal dissection and is associated with high risk of complications. Careful surgical planning and preparation are essential.

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Condition tags

chronic_pelvic_pain

MeSH descriptors

Adnexal Diseases Ovary Pelvic Pain Adnexal Diseases Adnexal Diseases Adult Cohort Studies Female Gynecologic Surgical Procedures Humans Laparoscopy Laparotomy Ovary Ovary Pelvic Pain Pelvic Pain Retrospective Studies Treatment Outcome Ultrasonography

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