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.