Surgical management of ovarian torsion in children: Detorsion, cyst/mass excision, and ovarian fixation.

This study evaluated surgical interventions based on the presence or absence of ovarian cysts or masses in pediatric and adolescent patients with ovarian torsion (OT) and analyzed their impact on retorsion development. A retrospective review was conducted on 25 ovaries from 23 patients under 18 years of age who underwent surgery for OT between July 2019 and January 2025. Patients were divided into two groups: Group 1 (n = 14), with ovarian or paraovarian cysts or masses that were excised; and Group 2 (n = 11), without detectable lesions. Detorsion was performed in all cases, and adnexal fixation was selectively applied based on intraoperative findings. All Group 1 patients underwent cyst or mass excision, and no retorsion was observed. All lesions were histologically benign. In Group 2, retorsion occurred in patients with high-risk features such as solitary ovary, elongated uteroovarian ligament, or a history of contralateral torsion. Uteroovarian ligament plication (UOP) was performed in four ovaries from three Group 2 patients. The difference in fixation rates between the groups was statistically significant (p = 0.026). No postoperative complications were noted. Excision of associated cysts or masses may reduce recurrence in OT, while adnexal fixation appears to be a safe, feasible option for lesion-free patients with anatomical risk factors.