Ovarian remnant syndrome

Magtibay, Paul M. MD
Nyholm, Jessica L. MD
Hernandez, Jose L.
Podratz, Karl C. MD, PhD

^aDivision of Gynecologic Surgery and the Division of Biostatistics, Mayo Clinic, Scottsdale, AZ
^bDivision of Gynecologic Surgery, Mayo Clinic, Rochester, MN

^* Reprint requests: Paul M. Magtibay, MD, Division of Gynecologic Surgery, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259. E-mail:[email protected]

Presented at the 31st Annual Meeting of the Society of Gynecologic Surgeons, April 4–6, 2005, Rancho Mirage, CA.

American Journal of Obstetrics and Gynecology 193(6):p 2062-2066, December 2005.

Objective

This study was undertaken to examine surgical management of patients with ovarian remnant syndrome.

Study design

Data were abstracted from records of patients with a history of bilateral salpingo-oophorectomy who were treated surgically at Mayo Clinic between 1985 and 2003 for pathologically confirmed residual ovarian tissue. A follow-up questionnaire was also mailed.

Results

Records review identified 186 patients (mean age, 37.6 years; mean follow-up, 1.2 years). Of 180 patients with available data, 153 (85%) underwent oophorectomy by laparotomy, 13 (7%) by laparoscopy, and 14 (8%) by transvaginal approach, mostly for endometriosis (56.8%). Of 186 patients, 105 (57%) presented with pelvic masses and 89 (48%) with pelvic pain. Remnant ovarian tissue was associated with a corpus luteum in 78 (42%) and endometriosis in 54 (29%). The intraoperative complication rate was 9.6%. Of 142 patients, 12 (9%) required subsequent re-exploration (1 ovarian remnant identified).

Conclusion

This heavily pretreated population has modest risk of bowel, bladder, or ureteral trauma with definitive pelvic sidewall stripping and apical vaginal excision. However, subsequent recurrence is minimal (<1%). More than 90% of patients reported resolution or marked improvement of symptoms.