PubMed · 4010163
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M P Pavlovskiĭ, L V Shengera. 1985. [Appendectomy as an additional operation].. https://pubmed.ncbi.nlm.nih.gov/4010163/
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A case of non-simultaneous bilateral adnexal torsion is described. Adnexal torsion is uncommon, rarely diagnosed preoperatively, and is most often treated by removal of the adnexa. However, if prompt diagnosis is made and viable tissue found (laparoscopy may be helpful), the opportunity of untwisting the adnexa and salvaging of ovarian function and fertility should be taken. In this situation, some authors recommend ovariopexy to prevent recurrence. Prophylactic suspension of the contralateral adnexa may, in some instances prevent subsequent recurrence on the contralateral side.
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OBJECTIVES: This study was conducted to assess the value of laparoscopic management of adnexal masses. Two concerns we wish to address are the failure to diagnose early ovarian cancer at laparoscopy and worsening the prognosis of stage I cancer by spilling fluid during surgery. STUDY DESIGN: The setting is a predominantly referral-based, private subspecialty practice. All operations were preformed in the outpatient surgical suite of a large suburban hospital. After extensive patient screenings, which included history and physical examination, preoperative serum CA 125 levels (since 1988), and pelvic ultrasonography, 1209 adnexal masses were managed laparoscopically. RESULTS: Of 1011 patients with surgical management, ovarian cancer was discovered intraoperatively in four. CONCLUSIONS: Our findings indicate that with consistent use of frozen sections of all cyst walls and suspicious tissue, laparoscopic management did not alter the prognosis. Neither CA 125 level, pelvic ultrasonography, nor peritoneal cytologic testing had sufficient diagnostic specificity to predict malignancy. Experienced surgeons using intraoperative histologic sampling may safely evaluate adnexal mass laparoscopically.