LAPAROSCOPIC MANAGEMENT OF OVARIAN REMNANT SYNDROME

Ceana Nezhat, MD, Camran Nezhat, MD, Susan Kearney, MHSE,
Shazia Malik, MD, Farr, Nezhat, MD

Objective:
   Results of laparoscopic management of 57 patients with ovarian remnant syndrome (ORS).

Materials and Methods:
   Prospective chart review of 57 patients with confirmed ORS who underwent laparoscopic resection using multi-puncture operative laparoscopy.

Results:
   The mean age of the patients at the time of laparoscopy for ORS was 38 (range 22 to 57). The patients had an average of 4 previous abdominopelvic surgeries (range 1 to 11). The mean of prior laparotomies was 2 (range 0 to 6) and the mean of prior laparoscopies were performed to remove ovarian remnants, with 5 patients undergoing 2 laparoscopies. Two cases were converted to laparotomy and one to mini-laparotomy for bowel resection. The time interval between oophorectomy and laparoscopy for ORS ranged from 3 to 372 months (mean 49.6). All patients had pelvic pain except for one who had a recurrent large cystic mass. In 41 (72%) cases pelvic mass was diagnosed by imaging (35 by ultrasound, 5 by CT scan, and 1 by both). The majority of ovarian remnants were found attached to one or more of the following: ureter, bowel, pelvic sidewall, bladder, rectum, and uterosacral ligament. Intraoperative complications occurred in 4 cases (3 enterotomy and 1 cystotomy. Twelve minor! postoperative complications occurred including urinary tract infection, hematuria, umbilical incision infection and cardiac tachycardia. Three major postoperative complications occurred: one umbilical omental hernia, one wound abscess requiring reoperation, and one vesicovaginal fistula. Adhesions were present in all cases, endometriosis in 51%, and fibrosis in 30%. Five patients underwent 2 laparoscopies for the resection of ORS during the study period. Three patients may have continued ORS as indicated by laboratory values and pelvic pain.

Conclusion:
   Surgical management of ovarian remnant remains complex by laparotomy or laparoscopy. In experienced hands and selected patients, laparoscopy results in acceptable outcomes with its associated advantages over laparotomy.
Keywords:
   Operative laparoscopy, ovarian remnant, pain relief, complications