Surgical approaches to recurring torsions and the effects of the attacks on the ovarian reserve: a case study in light of the literature

Objective: To report the effects of the torsion attacks on the ovarian reserve, and to present the surgical approach in cases of ovary torsion that develop after preventive surgery. Design: The presentation of the case. Setting: University hospital. The patient: The sixteen-years-old girl, who had lost her right adnexa because o f torsion, suffered successive torsion in the left adnexa after preventive surgery. Intervention: Through the laparoscopic method, the utero-ovarian ligament was shortened and ovariopexy was applied to the back o f the uterus. The ovarian reserve between the attacks was monitored. Main Outcome Measure: The prevention o f recurring torsions through the surgical method and thereby the preservation o f the ovarian reserve. Result: The ovary must be protected under all circumstances during the treatment o f torsion. More than one method o f adnexa fixation may prove necessary to prevent further attacks. Conclusion: The case we present here is the unique in which the two sides were successively affected, despite the surgical intervention to prevent any recurrence, and also the unique in which the ovarian reserve between the attacks was monitored. Apparently, the ovarian reserve is affected badly by recurrent torsion attacks. The ovarian reserve tests indicate some improvement in the months following the last attack.