Laparoscopic management of ovarian remnant.

OBJECTIVE

To report outcomes of laparoscopic management of patients with ovarian remnant (OR).

DESIGN

Retrospective chart review.

SETTING

Referral practice and tertiary medical center.

PATIENT(S): Sixty-four patients with confirmed OR who underwent laparoscopic treatment between July 1989 and September 2003.

INTERVENTION(S): Laparoscopic excision of OR.

MAIN OUTCOME MEASURE(S): Technical feasibility and recurrence.

RESULT(S): Sixty-nine laparoscopies were performed to remove ovarian remnants, with five patients requiring two laparoscopies. Two cases were converted to laparotomy and one to mini-laparotomy for bowel resection. In 64% (41 out of 64), pelvic mass was diagnosed by imaging (35 by ultrasound, 5 by computerized tomography [CT], 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 four cases: three enterotomy and repair; one cystotomy and repair. Twelve minor postoperative complications occurred including urinary tract infection, hematuria, umbilical incision infection, and transient tachycardia. Three major postoperative complications occurred: one umbilical omental hernia, one wound abscess requiring operation, and one vesicovaginal fistula. Adhesions were present in all cases, endometriosis in 55% (35 out of 64), and fibrosis in 30% (19 out of 64).

CONCLUSION(S): In experienced hands, laparoscopic treatment of OR results in acceptable outcomes with its associated advantages over laparotomy.