Role of oophoropexy in pediatric primary ovarian torsion without adnexal lesions: A systematic review and meta-analysis

Background: Primary ovarian torsion (POT) affects a morphologically normal ovary without associated adnexal lesions and that carries a high recurrence risk. The role of oophoropexy in preventing POT recurrence remains unclear. Objective: To evaluate the effectiveness of oophoropexy in reducing recurrence rates after the first episode of POT. Methods: A systematic review and meta-analysis was conducted following PRISMA 2020 guidelines. Retrospective studies including girls <18 years undergoing surgery for POT were considered. The primary outcome was torsion recurrence. Study quality was assessed using the MINORS tool. Results: Twelve studies (209 patients; mean age 7.8 ± 4.1 years) met inclusion criteria. Detorsion alone was performed in 168 patients (80.4 %) and detorsion + oophoropexy in 41 patients (19.6 %). Recurrence occurred in 17.3 % of patients after ovarian detorsion alone versus 4.9 % after detorsion + oophoropexy. Three comparative studies (106 patients) were included in the meta-analysis. Pooled analysis showed a trend toward reduction in recurrence for oophoropexy (OR 0.54, 95 % CI 0.17–1.72, p = 0.15, I2 = 0 %). Ultrasonography demonstrated preserved ovarian vascularization and trophism in most patients. Conclusions: POT carries a substantial risk of recurrence. Oophoropexy may reduce recurrence compared with detorsion alone without negatively affecting ovarian trophism, although statistical significance was not reached. At present, oophoropexy cannot yet be recommended as routine after a first episode of POT, but it appears to hold promise as a strategy to reduce recurrence.