Excellent prognosis and retention of ovarian function is expected with timely surgical intervention. With minimally invasive procedures such as laparoscopy and unwinding of the adnexa, complete recovery of normal ovarian function and fertility is expected.[58]Yasa C, Dural O, Bastu E, et al. Impact of laparoscopic ovarian detorsion on ovarian reserve. J Obstet Gynaecol Res. 2017 Feb;43(2):298-302.
http://www.ncbi.nlm.nih.gov/pubmed/27928855?tool=bestpractice.com
[59]Geimanaite L, Trainavicius K. Ovarian torsion in children: management and outcomes. J Pediatr Surg. 2013 Sep;48(9):1946-53.
http://www.ncbi.nlm.nih.gov/pubmed/24074673?tool=bestpractice.com
[60]Balasubramaniam D, Duraisamy KY, Ezhilmani M. Laparoscopic detorsion and fertility preservation in twisted ischemic adnexa - a single-center prospective study. Gynecol Minim Invasive Ther. 2020 Jan 23;9(1):24-8.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7008646
http://www.ncbi.nlm.nih.gov/pubmed/32090009?tool=bestpractice.com
Fertility
Many studies have shown evidence of subsequent ovarian function from the affected ovary.[3]Oelsner G, Shashar D. Adnexal torsion. Clin Obstet Gynecol. 2006 Sep;49(3):459-63.
http://www.ncbi.nlm.nih.gov/pubmed/16885653?tool=bestpractice.com
[20]Bider D, Mashiach S, Dulitzky M, et al. Clinical, surgical and pathologic findings of adnexal torsion in pregnant and nonpregnant women. Surg Gynecol Obstet. 1991 Nov;173(5):363-6.
http://www.ncbi.nlm.nih.gov/pubmed/1948585?tool=bestpractice.com
[58]Yasa C, Dural O, Bastu E, et al. Impact of laparoscopic ovarian detorsion on ovarian reserve. J Obstet Gynaecol Res. 2017 Feb;43(2):298-302.
http://www.ncbi.nlm.nih.gov/pubmed/27928855?tool=bestpractice.com
[61]Mashiach S, Bider D, Moran O, et al. Adnexal torsion of hyperstimulated ovaries in pregnancies after gonadotropin therapy. Fertil Steril. 1990 Jan;53(1):76-80.
http://www.ncbi.nlm.nih.gov/pubmed/2295348?tool=bestpractice.com
[65]Ben-Rafael Z, Bider D, Mashiach S. Laparoscopic unwinding of twisted ischemic hemorrhagic adnexum after in vitro fertilization. Fertil Steril. 1990 Mar;53(3):569-71.
http://www.ncbi.nlm.nih.gov/pubmed/2137796?tool=bestpractice.com
[68]Cohen SB, Wattiez A, Seidman DS, et al. Laparoscopy versus laparotomy for detorsion and sparing of twisted ischemic adnexa. JSLS. 2003 Oct-Dec;7(4):295-9.
http://www.ncbi.nlm.nih.gov/pubmed/14626393?tool=bestpractice.com
[74]Descargues G, Tinlot-Mauger F, Gravier A, et al. Adnexal torsion: a report on forty-five cases. Eur J Obstet Gynecol Reprod Biol. 2001 Sep;98(1):91-6.
http://www.ncbi.nlm.nih.gov/pubmed/11516806?tool=bestpractice.com
[75]Shalev E, Mann S, Romano S, et al. Laparoscopic detorsion of adnexa in childhood: a case report. J Pediatr Surg. 1991 Oct;26(10):1193-4.
http://www.ncbi.nlm.nih.gov/pubmed/1838120?tool=bestpractice.com
In one study, ovarian function returned in 93% of patients.[3]Oelsner G, Shashar D. Adnexal torsion. Clin Obstet Gynecol. 2006 Sep;49(3):459-63.
http://www.ncbi.nlm.nih.gov/pubmed/16885653?tool=bestpractice.com
[68]Cohen SB, Wattiez A, Seidman DS, et al. Laparoscopy versus laparotomy for detorsion and sparing of twisted ischemic adnexa. JSLS. 2003 Oct-Dec;7(4):295-9.
http://www.ncbi.nlm.nih.gov/pubmed/14626393?tool=bestpractice.com
These results are replicated in children treated conservatively for ovarian torsion.[17]Cass DL. Ovarian torsion. Semin Pediatr Surg. 2005 May;14(2):86-92.
http://www.ncbi.nlm.nih.gov/pubmed/15846564?tool=bestpractice.com
[57]Dasgupta R, Renaud E, Goldin AB, et al. Ovarian torsion in pediatric and adolescent patients: a systematic review. J Pediatr Surg. 2018 Jul;53(7):1387-91.
http://www.ncbi.nlm.nih.gov/pubmed/29153467?tool=bestpractice.com
[59]Geimanaite L, Trainavicius K. Ovarian torsion in children: management and outcomes. J Pediatr Surg. 2013 Sep;48(9):1946-53.
http://www.ncbi.nlm.nih.gov/pubmed/24074673?tool=bestpractice.com
[75]Shalev E, Mann S, Romano S, et al. Laparoscopic detorsion of adnexa in childhood: a case report. J Pediatr Surg. 1991 Oct;26(10):1193-4.
http://www.ncbi.nlm.nih.gov/pubmed/1838120?tool=bestpractice.com
[76]Templeman C, Hertweck SP, Fallat ME. The clinical course of unresected ovarian torsion. J Pediatr Surg. 2000 Sep;35(9):1385-7.
http://www.ncbi.nlm.nih.gov/pubmed/10999708?tool=bestpractice.com
Recurrence
The exact risk of recurrent ipsilateral or asynchronous contralateral ovarian torsion is not known. It seems to range from 2% to 5%.[18]Beaunoyer M, Chapdelaine J, Bouchard S, et al. Asynchronous bilateral ovarian torsion. J Pediatr Surg. 2004 May;39(5):746-9.
http://www.ncbi.nlm.nih.gov/pubmed/15137011?tool=bestpractice.com
[67]Oelsner G, Cohen SB, Soriano D, et al. Minimal surgery for the twisted ischaemic adnexa can preserve ovarian function. Hum Reprod. 2003 Dec;18(12):2599-602.
http://humrep.oxfordjournals.org/content/18/12/2599.full
http://www.ncbi.nlm.nih.gov/pubmed/14645177?tool=bestpractice.com
Recurrence is more common in children with no underlying pathology found at the time of ovarian torsion surgery, with the risk reported from 2% to 35%.[17]Cass DL. Ovarian torsion. Semin Pediatr Surg. 2005 May;14(2):86-92.
http://www.ncbi.nlm.nih.gov/pubmed/15846564?tool=bestpractice.com
[18]Beaunoyer M, Chapdelaine J, Bouchard S, et al. Asynchronous bilateral ovarian torsion. J Pediatr Surg. 2004 May;39(5):746-9.
http://www.ncbi.nlm.nih.gov/pubmed/15137011?tool=bestpractice.com
[77]Smorgick N, Melcer Y, Sarig-Meth T, et al. High risk of recurrent torsion in premenarchal girls with torsion of normal adnexa. Fertil Steril. 2016 Jun;105(6):1561-5.e3.
http://www.ncbi.nlm.nih.gov/pubmed/26926251?tool=bestpractice.com
Should torsion recur, treatment is the same.