Laparoscopic excision of ovarian remnants: retrospective cohort study with long-term follow-up

Abstract

Study objective: To review the clinical presentation, surgical and pathologic findings, and long-term outcomes after excision of ovarian remnants using a predominantly laparoscopic approach.

Design: Retrospective medical record review and long-term follow-up via telephone interview (Canadian Task Force classification II-3).

Setting: Large academic medical institution.

Patients: Thirty women who underwent excision of pathologically confirmed ovarian remnants by a single surgeon between 2001 and 2009.

Intervention: Excision of ovarian remnants, 29 at laparoscopy and 1 at laparotomy.

Measurements and main results: Of the 30 patients, 29 had pain and 1 had a persistent adnexal mass. Of the 29 patients who underwent preoperative ultrasonography, 26 (89.6%) had an adnexal mass on the side of previous salpingo-oophorectomy. Masses ranged in size from 0.8 to 7.4 cm in greatest diameter and most commonly contained debris-filled cysts. Intraoperatively, 29 excisions (96.7%) required retroperitoneal dissection, 27 (90.0%) required enterolysis, 28 (93.3%) required ureterolysis, and 20 (66.7%) required ligation of the uterine artery at its origin. All pathology reports confirmed ovarian tissue, often associated with endometriosis, corpus luteal cysts, and simple cysts. Four bowel injuries and 2 bladder injuries were laparoscopically repaired by the primary surgeon. Three patients required bowel resections by a general surgeon. Records from postoperative visits were available for 28 patients, of whom 17 (60.7%) reported resolution of pain, 9 (32.1%) reported improvement, and 2 (7.1%) reported persistent pain. Of the 18 women who returned written consent for the telephone interview, 11 (61.1%) reported resolution of pain, 5 (27.8%) reported improvement, and 2 (11.1%) reported persistent pain.

Conclusion: While laparoscopic excision of ovarian remnants is feasible, the procedure almost always requires a retroperitoneal dissection and is associated with high risk of complications. Careful surgical planning and preparation are essential.