Türkiye'de Tersiyer Bir Hastanede Üreme Çağı Grubunda Adneksiyal Torsiyon Tedavisinde Laparotomi ve Laparoskopik Cerrahinin Karşılaştırılması

Year 2025, Volume: 7 Issue: 3, 323 - 330, 13.10.2025

Bekir Sıtkı İsenlik , Ödül Özkan Kalfagil , Sinem Tuzcuoğlu , Orkun Han , Zeynep Ozturk Inal , Hasan İnal

https://doi.org/10.52827/hititmedj.1634267

Abstract

Amaç: Kliniğimizde son 10 yıl içinde adneksal torsiyon nedeniyle cerrahi müdahale geçiren hastaların sosyodemografik ve klinik özelliklerini, laboratuvar ve patoloji sonuçlarını geriye dönük olarak değerlendirmek.
Gereç ve Yöntem: Ocak 2014 ile Aralık 2024 arasında adneksal torsiyon nedeniyle cerrahi işlemler geçiren 176 hasta çalışmaya geriye dönük ve ardışık olarak dahil edilmiştir; bunlardan 146'sı laparoskopi (L/S) ile (Grup 1) ve 30'u laparotomi ile (Grup 2) tedavi edilmiştir. Katılımcıların sosyodemografik ve klinik özellikleri ile laboratuvar ve histopatoloji sonuçları geriye dönük olarak kaydedilmiş ve karşılaştırılmıştır.
Bulgular: Gruplar arasında yaş, vücut kitle indeksi, sigara durumu, alkol kullanımı, gravidisite, kitle boyutu, başvuru sırasında semptomlar, torsiyone tur sayısı, torsiyone taraf, nekroz varlığı, pre- ve postoperatif hemoglobin seviyeleri, lökosit, nötrofil, lenfosit, monosit ve trombosit sayıları, kırmızı hücre dağılım genişliği, nötrofil-lenfosit oranı, trombosit-lenfosit oranı, C-reaktif protein veya eritrosit sedimentasyon hızı değerleri açısından herhangi bir fark gözlemlenmemiştir; ancak operasyon süresinde (40.81±18.09 vs 82.33±18.03, p<0.001) ve hastanede yatış gününde (3.12±1.15 vs 4.33±1.54, p=0.002) anlamlı farklılıklar belirlenmiştir. Detorsiyon + kistektomi en sık gerçekleştirilen cerrahi prosedür olurken, olgun kistik teratom en sık gözlemlenen histopatolojik bulgudur.
Sonuç: Bu çalışma, L/S'nin üreme çağındaki adnexial torsiyonu olan kadınlarda sıkça gerçekleştirilen bir cerrahi prosedür haline geldiğini göstermiştir. Bu çalışmanın sonuçları, daha fazla katılımcı içeren araştırmalarla doğrulanmalıdır.

Keywords

Adneksiyal torsiyon , klinik özellik , laparoskopi , laparatomi

Ethical Statement

Çalışma için 23/05/2024 tarihinde Antalya Eğitim ve Araştırma Hastanesi Klinik Araştırmalar Etik Kurulu’ndan onay alınmıştır. Karar no: 7/15

A Comparison of Laparotomy and Laparoscopic Surgery in the Treatment of Adnexal Torsion in the Reproductive Age Group at a Tertiary Care Hospital in Türkiye

Abstract

Objective: To retrospectively evaluate the sociodemographic and clinical characteristics, and laboratory and pathology results of patients who underwent surgical intervention due to adnexal torsion in our clinic over the previous 10 years.
Materials and methods: A hundred and seventy six patients who underwent surgical procedures due to adnexal torsion, 146 of whom were treated with laparoscopy (L/S) (Group 1) and 30 with laparotomy (Group 2), between January 2014 and December 2024, were retrospectively and consecutively included in the study. The participants' sociodemographic and clinical characteristics, and laboratory and histopathology results were retrospectively recorded and compared.
Results: While no difference was observed between the groups in terms of age, body mass index, smoking status, alcohol use, gravidity, mass size, symptoms on admission, torsion turn number, the torsioned site, presence of necrosis, pre- and postoperative hemoglobin levels, white blood cell count, neutrophil, lymphocyte, monocyte, and platelet counts, red cell distribution width, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, C-reactive protein, or erythrocyte sedimentation rate values, significant differences were determined in operative times (40.81±18.09 in Group 1 vs 82.33±18.03 in Group 2, p<0.001) and hospitalization days (3.12±1.15 vs 4.33±1.54, p=0.002). Detorsion + cystectomy was the most commonly performed surgical procedure, while mature cystic teratoma was the most frequently observed histopathological finding.
Conclusion: This study showed that L/S has established itself as a frequently performed surgical procedure in women of reproductive age with adnexal torsion. The results of this study should now be confirmed by research involving larger numbers of participants.

Keywords

adnexial torsiyon , clinical feature , laparoscopy , laparatomy

Ethical Statement

Approval for the study was obtained from the Antalya Training and Research Hospital Clinical Research Ethics Committee on 23/05/2024. Decision no: 7/15

References

• Melcer Y, Maymon R, Pekar-Zlotin M, Vaknin Z, Pansky M, Smorgick N. Does she have adnexal torsion? Prediction of adnexal torsion in reproductive age women. Arch Gynecol Obstet 2018;297:685-690.
• Sasaki KJ, Miller CE. Adnexal torsion: review of the literature. J Minim Invasive Gynecol 2014;21:196-202.
• Chang-Patel EJ, Palacios-Helgeson LK, Gould CH. Adnexal torsion: a review of diagnosis and management strategies. Curr Opin Obstet Gynecol 2022;34:196-203.
• Ling-Shan C, Jing L, Zheng-Qiu Z, et al. Computed Tomography Features of Adnexal Torsion: A Meta-Analysis. Acad Radiol 2022;29:317-325.
• Moro F, Bolomini G, Sibal M, et al. Imaging in gynecological disease (20): clinical and ultrasound characteristics of adnexal torsion. Ultrasound Obstet Gynecol 2020;56:934-943.
• Sugi MD, Patel AG, Yi J, Patel MD. The Flipped Ovary Sign in Ovarian Torsion. J Ultrasound Med 2021;40:839-843.
• Birsen MB, Erturk D, Onder D, et al. Practicability of Serum Kallistatin Levels as a Biomarker in the Diagnosis of TuboOvarian Abscess. Surg Infect (Larchmt) 2024;25:668-673.
• Inal ZO, Inal HA. Bilateral Dermoid Cysts of the Ovaries in a Term Pregnant Woman: A Case Report. Anatol JFM 2018;2:67-69.
• Smorgick N, Maymon R, Mendelovic S, Herman A, Pansky M. Torsion of normal adnexa in postmenarcheal women: can ultrasound indicate an ischemic process? Ultrasound Obstet Gynecol 2008;31(3):338-341.
• Tsafrir Z, Azem F, Hasson J, et al. Risk factors, symptoms, and treatment of ovarian torsion in children: the twelve-year experience of one center. J Minim Invasive Gynecol 2012;19:29-33.
• Shadinger LL, Andreotti RF, Kurian RL. Preoperative sonographic and clinical characteristics as predictors of ovarian torsion. J Ultrasound Med 2008;27:7-13.
• Lee JH, Park SB, Shin SH, et al. Value of intra-adnexal and extra-adnexal computed tomographic imaging features diagnosing torsion of adnexal tumor. J Comput Assist Tomogr 2009;33:872-876.
• Tobiume T, Shiota M, Umemoto M, Kotani Y, Hoshiai H. Predictive factors for ovarian necrosis in torsion of ovarian tumor. Tohoku J Exp Med 2011;225:211-214.
• McCloskey K, Grover S, Vuillermin P, Babl FE. Ovarian torsion among girls presenting with abdominal pain: a retrospective cohort study. Emerg Med J 2013;30:e11.
• Galinier P, Carfagna L, Delsol M, et al. Ovarian torsion. Management and ovarian prognosis: a report of 45 cases. J Pediatr Surg 2009;44:1759-1765.
• Lo LM, Chang SD, Horng SG, Yang TY, Lee CL, Liang CC. Laparoscopy versus laparotomy for surgical intervention of ovarian torsion. J Obstet Gynaecol Res 2008;34:1020-1025.
• Oelsner G, Cohen SB, Soriano D, Admon D, Mashiach S, Carp H. Minimal surgery for the twisted ischaemic adnexa can preserve ovarian function. Hum Reprod 2003;18:2599-2602.
• Cohen SB, Wattiez A, Seidman DS, et al. Laparoscopy versus laparotomy for detorsion and sparing of twisted ischemic adnexa. JSLS 2003;7:295-299.
• Ghandehari H, Kahn D, Glanc P. Ovarian Torsion: Time Limiting Factors for Ovarian Salvage. Emerg Med (Los Angel) 2015;5:273.
• Celik A, Ergün O, Aldemir H, et al. Long-term results of conservative management of adnexal torsion in children. J Pediatr Surg 2005;40:704-708.
• Weitzman VN, DiLuigi AJ, Maier DB, Nulsen JC. Prevention of recurrent adnexal torsion. Fertil Steril 2008;90:2018.e1-3.
• Eitan R, Galoyan N, Zuckerman B, Shaya M, Shen O, Beller U. The risk of malignancy in post-menopausal women presenting with adnexal torsion. Gynecol Oncol 2007;106:211-214.