Surgery for Ovarian Torsion
Surgery is the treatment of choice in the management of ovary torsion, where the primary goal is evading irreversible damage to the organ. Historically, laparotomy has been the standard procedure, where ovary was removed in entirety as a way of minimizing possible post-operative thromboembolic events. However, a growing body of evidence has discredited the views, noting that untwisting of the ovary can be resolved without removing the ovary. The revelation has shifted the focus to restoring hormonal functions and fertility, a centrality where the treatment focus is detorsion through laparoscopy (Gomel & Brill, 2010). Laparoscopy also offers significant benefits such as surgical evaluation, an advantage that is critical in making informed decisions and determining the extent of the damage. Nevertheless, oophorectomy may be preferred in instances of clinical severity, as the case where ovary is adversely affected by an extended disruption of circulatory supply as well as necrotic developments (Arias, Bhide, Arulkumaran, Damania, & Daftary, 2012) In the event the surgical evaluation shows that ovary is non-viable, salpingo-oophorectomy can be an alternative process.
While the preferred way of uncoiling the torsed ovary is laparoscopy, realizing treatment outcome calls for hybrid conservative management that also entails other operations. For example, while oophoropexy helps in fixating the ovary and preventing reoccurrence, cystectomy drains ovarian cyst (Gomel & Brill, 2010). Besides the general treatment rationale, there are considerations in some population segments that should guide the management. For instance, reconstruction is the primary objective among women in their reproductive years, infants, and children. In patients where treatment does not culminate to better outcomes as the case of individuals who have an inherent susceptibility to peritonitis and systemic infections, as well as persons with increased risk of malignancy as the case of post-menopausal years, excision is the best choice (Gomel & Brill, 2010).
References
Arias, F., Bhide, A. G., Arulkumaran, S., Damania, K., & Daftary, S. N. (Eds.). (2012). Practical Guide to High-Risk Pregnancy and Delivery-E-Book. Elsevier health sciences.
Gomel, V., & Brill, A. (Eds.). (2010). Reconstructive and reproductive surgery in gynecology. CRC Press.
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