OVARIAN REMNANT SYNDROME

P.M. Magtibay, J.L. Nyholm, J.L. Hernandez, K.C. Podratz

Mayo Clinic Foundation, Rochester, MN

OBJECTIVE: To examine a cohort of 186 patients managed for ovarian remnant syndrome at Mayo Clinic from 1985 through 2003.

MATERIALS AND METHODS: Data was abstracted from the records of 186 patients with a prior history of bilateral salpingo-oophorectomy (BSO) and subsequent pathologic confirmation of residual ovarian tissue following surgical re-exploration which included excision of the pelvic-sidewall peritoneum and the vaginal apex.  A questionnaire was mailed to all patients in an attempt to secure updated information.

RESULTS:  The mean age of the cohort was 37.6 years (20 to 73 years) with a mean follow-up of 1.2 years (0.1 to 15.6 years).  Of the patients with available data, 90% (153/170) underwent oophorectomy via laparotomy, 13 (7.6%) via laparoscopy and/or 14 (8.2%) via a transvaginal approach.   The most common indication for bilateral oophorectomy was endometriosis (56.8%).   The mean number of laparotomies and laparoscopies prior to ovarian remnant surgery at Mayo Clinic was 1.4 (0 to 8) and 0.77 (0 to 10), respectively. Of the 186 patients, 105 (56.5%) presented with a pelvic mass and 89 (47.8%) had a variant of pelvic pain including dyspareunia (26.3%), dysuria (6.5%) and/or pain with defecation (5.9%).  Despite not receiving estrogen replacement therapy 70 (37%) denied symptoms of estrogen deficiency. Conversely, 77 (41.4%) were immediately place on estrogen replacement therapy following BSO.

Preoperative FSH testing was conducted in 61 (33%) patients with 19 (31.2%) demonstrating menopausal levels of >30mIU/mL. The remnant ovarian tissue was associated with a corpus luteum in 78 patients (42%) and endometriosis in 54 (29%).   The intraoperative complication rate was 9.6% including enterotomy/colotomy (5.4%), cystotomy (1.6%) and ureteral injury (1.1%). In addition, 22 (12.2%) patients required transfusion and 3 (1.6%) required a return to the operating room.

Based on abstracted clinic records and/or responses from the questionnaire 12 of 142 (8%) patients with mean surveillance of 15 months required a subsequent reexploration including 10 for persistent pelvic pain and 2 for ureteral stenosis.  In only 1 of the 12 patients subjected to reoperation was an ovarian remnant identified.  

CONCLUSIONS: In a large cohort of patient treated for ovarian remnant syndrome, endometriosis was the most common primary indicator for oophorectomy. There is modest risk of bowel, bladder, and ureteral trauma with definitive pelvic sidewall striping and apical vaginal excision in this heavily pretreated/operated population.   However, the subsequent recurrence rate is indeed minimal (<1%) with complete resolution or marked improvement of symptoms in >90% of the patients.

Key Words:  ovarian remnant syndrome 

Disclosure – Nothing to disclose.