Ovarian remnant syndrome at the port site
ABSTRACT Ovarian remnant syndrome is a rare gynecologic complication, mostly induced by difficult salpingo-oophorectomy with the residual ovarian tissue on the pelvic side wall. This is a report of a rare case of ovarian remnant syndrome at a port site after laparoscopic oophorectomy and a review of the related literature. A 22-year-old virgin had a laparoscopic oophorectomy for an endometrioma 5 years earlier. Postoperatively, she visited gynecologic clinics for a frequent painful sensation at the left port site. After sonographic examination and under the impression of a recurrent endometrioma, laparotomy and cyst excision were performed. Surprisingly, ectopic ovary was diagnosed by the pathologist. Review of the literature revealed ovarian remnant implantation at a port site as a very rare type of ovarian remnant syndrome. During laparoscopic oophorectomy in a woman without sexual exposure who is not a good candidate for culdotomy, the removal of the excised ovary through the port site is sometimes difficult and residual ovarian tissue implantation may occur. There are many methods to reduce the risk of port-site seeding, which we must keep in mind and execute to prevent such a complication.
Article: Management of chronic pelvic pain.[Show abstract] [Hide abstract]
ABSTRACT: Chronic pelvic pain is a complex condition that requires evaluation of the reproductive, gastrointestinal, urologic, musculoskeletal, psychological, and neurological systems. Usually, diagnosis and management entail identifying a network of disorders rather than a single cause of pain with a definitive cure. Only disorders that we commonly encounter in our practice will be discussed in this review.Current Pain and Headache Reports 05/2011; 15(5):377-85. DOI:10.1007/s11916-011-0204-4 · 2.26 Impact Factor
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ABSTRACT: Ovarian remnant syndrome (ORS), a rare condition in which remnant ovarian tissue presents as a pelvic mass and/or pain after previous oophorectomy, poses a diagnostic and treatment challenge. This study reviews the recent studies in the past 5 years on the subject. Incomplete removal of ovarian tissue at the time of initial oophorectomy from inability to obtain adequate surgical margins or inappropriate extraction from the pelvic cavity during laparoscopy can cause ORS. Excision of ovarian remnant tissue is increasingly approached minimally invasively. Cases of malignant involvement of the remnant ovary have been reported. Endometriosis, recently suggested to increase the risk for ovarian cancer, predisposes to ORS and is associated with 50% of patients with ovarian carcinoma in ORS patients. Surgical excision remains the treatment of choice in ORS as malignancy can be associated with the remnant tissue. In cases of endometriosis, complete excision of endometriosis and ovarian tissue at the time of initial surgery prevents recurrence of endometriosis, subsequent development of ORS and possible ovarian malignant transformation.Current opinion in obstetrics & gynecology 06/2012; 24(4):210-4. DOI:10.1097/GCO.0b013e3283558539 · 2.37 Impact Factor
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ABSTRACT: BACKGROUND: The transvaginal approach is being used for natural orifice transluminal endoscopic surgery (NOTES), and reports of the clinical use of transvaginal NOTES have increased rapidly. However, hasty use of a transvaginal route may cause unexpected complications. Infertility or dyspareunia after transvaginal NOTES in young women is one of the most important issues to be resolved. The purpose of this study was to assess long-term complications, including infertility and dyspareunia, after transvaginal peritoneal surgery. METHODS: An anonymous questionnaire was sent to 73 young patients who had undergone ovarian cystectomy using a transvaginal approach from 2003 to 2011. The questionnaire contained 15 questions; 6 dealt with fertility, and 8 dealt with discomfort after surgery. A 5-point scale was used to evaluate patients' overall satisfaction with surgery. RESULTS: Forty-four (60 %) questionnaires were returned. The patients' mean age was 33.0 years, and the mean postoperative follow-up period was 16.5 months. Of responders younger than age 40 years, 24 did not use contraception, and 9 (38 %) conceived. The pregnancy rate among women younger than age 30 years was 60 %. Two (5 %) women reported temporary dyspareunia 1 month after surgery, but none developed permanent dyspareunia. The average patient satisfaction score was 4.12. CONCLUSIONS: There was no evidence to suggest that transvaginal peritoneal surgery causes infertility or dyspareunia. The majority of patients gave a high evaluation to vaginal ovarian cystectomy, suggesting the usability of a transvaginal approach for intraperitoneal surgery in young premenopausal women.Surgical Endoscopy 02/2013; 27(7). DOI:10.1007/s00464-012-2749-7 · 3.31 Impact Factor