Primary ovarian torsion in pediatric patients: is oophoropexy still an option? A 14-year single-center experience

Study objective: Pediatric primary ovarian torsion (POT) is a rare condition related to anatomical predispositions and hormonal triggers. The high recurrence rate of laparoscopic ovarian detorsion (LOD) has led to the consideration of primary oophoropexy (OPX). This study aims to investigate OPX indications in POT and evaluate the efficacy of different fixation techniques. Methods: A retrospective review was conducted on all pediatric patients (1-14 years) with POT treated with LOD or LOD+OPX at our tertiary care center between 2010 and 2024. The sites of fixation were round ligament, ovarian fossa, utero-ovarian ligament and uterine body. The data collected included demographic, clinical, imaging, surgical, and follow-up results. Statistical analyses were performed to identify factors associated with recurrence and to compare LOD with LOD+OPX. Results: Eighteen patients (median age 9.4 years) were included in the study. LOD was performed in 56% of cases, while LOD+OPX was performed in 44%. The overall recurrence rate was 44%, with 40% recurrence after LOD and 50% after LOD+OPX (p=1). Notably, all OPX cases involving the round ligament relapsed (100%), compared to a significantly lower recurrence rate for other OPX sites (20%). Statistical analysis confirmed the round ligament as an inadequate fixation site (p=0.027). Follow-up ultrasound revealed normal ovarian morphology in 62% of patients and signs of progressive ovarian atrophy in 38%. Conclusion: In our experience, POT predominantly occurred in premenarchal patients with hypermobile utero-ovarian ligaments. Given the high POT recurrence rate after LOD, adjunctive OPX effectively reduced the recurrence rate, except when fixation was performed at the round ligament