Efficacy of conservative laparoscopic surgical treatment for acute ovarian torsion in pediatrics and adolescent populations: A single-armed meta-analysis

Abstract

Conservative laparoscopic torsioning with or without cystectomy or oophoropexy has emerged as a promising approach for the management of ovarian torsion, particularly in pediatric populations. We sought to understand the efficacy of this approach. We comprehensively reviewed the relevant literature. We formulated a search strategy by combining keywords related to laparoscopic surgery, conservative management, and ovarian torsion in pediatric and adolescent populations. Data were retrieved from Web of Science, PubMed, Medline, Cochrane Library, and ClinicalTrials. The Gov and Scopus databases. Eligible articles met the following criteria: Involved pediatric or adolescent populations with ovarian or adnexal torsion and evaluating the use of any method of laparoscopic torsioning surgery. We included the following outcomes; recurrence, conversion to laparotomy, need for oophorectomy, mean time to the onset of symptoms, abdominal pain at the time of presentation, fever, and evidence of ovarian function on postoperative ultrasound. In our meta-analysis, conducted using OpenMeta[Analyst], we analyzed both continuous and dichotomous data with mean difference and risk ratio, respectively, along with 95% confidence intervals (CI). First, the incidence of recurrence was reported in five studies, where 17 cases experienced recurrence out of 391 cases experienced recurrence. Additionally, instances requiring open surgery were documented in five studies, with 22 out of 360 cases requiring this conversion to open surgery, resulting in a combined ratio of 0.051 [95% CI (0.018, 0.083), p=0.02]. Moreover, six studies provided data on cases necessitating oophorectomy, with 27 out of 437 cases requiring the procedure. Furthermore, the mean time from symptom onset to surgery was 51.9 h. Abdominal pain was prevalent at presentation, affecting 264 out of 324 patients. Fever was less frequently reported, with 19 out of 324 patients experiencing it. Finally, a high percentage of patients showed evidence of ovarian function on postoperative ultrasound, with a pooled proportion of 0.69. Our analysis performed the conservative management of ovarian torsion in young women. Recurrence occurred in 17 out of 391, and 22 out of 360 required conversion to open surgery. Furthermore, oophorectomy was necessary in 27 of 437 patients, and the mean time from symptom onset to surgery was 51.9 h. Abdominal pain was the most common symptom, affecting 264 out of 324 cases, whereas fever was less common.

Keywords: Torsion; conservative management; laparoscopy; pediatrics.