Should oophoropexy be a standard procedure after ovarian torsion in premenarchal patients? A case-based review of fixation indications and techniques

Abstract

Introduction and aim. Ovarian torsion is a rare but significant cause of acute abdomen in children. Diagnosis is challenging due to nonspecific symptoms. While Doppler ultrasound is essential, it is not definitive. Laparoscopy with detorsion remains the diagnostic and therapeutic standard. For recurrent and high-risk cases, oophoropexy is considered, but there is no consensus on its indications or optimal technique. We analyze the diagnostic process, reasons for recurrence, and outcomes of different oophoropexy techniques. Description of the case. A premenarchal girl experienced three episodes of ipsilateral ovarian torsion. After the second recurrence, she underwent laparoscopic oophoropexy via fixation posterior to the uterus to the ovarian fossa with absorbable sutures, which failed. Following a third torsion, a laparotomy with a subsequent oophoropexy to the round ligament using non-absorbable sutures achieved a long-term recurrence-free period. Conclusion. Retorsion remains a significant risk. This case provides a unique intrapatient comparison, demonstrating that the technical approach influences the outcomes. Fixation to the abdominal wall with non-absorbable sutures proved to be superior in this scenario, preventing further recurrence. The patient's age and torsion etiology are critical in selecting a fixation method. This report highlights the potential for oophoropexy failure and offers vital technical insights, underscoring the need for further studies to standardize practices for fertility preservation.