2924 Oophoropexy in Adolescent Patients

Video Objective This video demonstrates a technique of oophoropexy through plication of the utero-ovarian ligament to the round ligament. Setting The patient is a 13 year old P0 with a history of right ovarian torsion 10 months prior, for which she underwent laparoscopic detorsion without oophoropexy. She re-presented to the ED with two weeks of severe intermittent right lower abdominal pain, associated with nausea and vomiting. MRI abdomen/pelvis revealed twisting of the right ovarian pedicle. In addition, the right ovary was enlarged due to ovarian stromal edema, and there was peripheralization of the follicles. There was no ovarian cyst or mass. At the time of evaluation, the patient was not experiencing pain and she was clinically stable. She was suspected to have intermittent torsion. The patient and her parents were counseled on the option of observation and outpatient follow up versus surgical management with oophoropexy. They desired to proceed with surgical management. Interventions Oophoropexy was performed with a horizontal mattress of non-absorbable Polyester suture from the round ligament, through the mesosalpinx, and to the utero-ovarian ligament. Conclusion Evidence supports ovarian oophoropexy rather than oophorectomy for recurrent ovarian torsion in adolescents. Despite this the National Inpatient Sample (NIS) estimates 78% of adolescents underwent oophorectomy. We demonstrate a method of oophoropexy for recurrent ovarian torsion. The case patient has remained asymptomatic since her procedure. In conclusion, oophoropexy should be considered for adolescent patients with recurrent ovarian torsion to decrease risk of recurrence and to preserve fertility.