Evaluation of long-term results after childhood and adolescent age ovarian surgery

Surgical intervention is often required in a wide variety of over and adnexal pathologies in childhood. Although it is rare than other surgical diseases of childhood, most of the ovarian and adnexal problems require surgical intervention. The aim of this study is to investigate the long-term results of surgical techniques applied in over pathology in children and adolescents. Between May 1995 and May 2015, 240 patients underwent surgery for adnexal pathology in our clinic. Complaints, ages, sexes, symptoms, preoperative laboratory results imaging studies, performed operations, postoperative hospital records were examined. In the second stage of our study clinical complaints, marital status, gestational history, menstrual features, oral contraceptive use, additional operative emoticons of patients were questioned. In addition, results of patients with blood hormone examinations and / or pelvic USG were recorded within the past year. The mean age of the patients at the time of operation was 13,8 ± 3,4. 58% of the cases were admitted to our clinic due to urgent complaints, and 42% of them were under elective conditions. 87.9% of the cases had only one operation in our clinic, whereas 10.4% had two operations and 1.6% had three operations. The number of operation due to over-mass was 85, the number of operation due to over-torsion was 66, and the number of operation due to over-cyst was 102. 79.6% of the cases (n = 191) were reached. 3 cases were lost during the follow-up period and 3 cases had bilateral oophorectomy. The mean age of the remaining 185 cases was 21,5 ± 5,8 [median age: 20,9 (4,0-36,3)], while the mean follow-up period was 7,6 ± 5,1 years [median follow-up time: 6 , 2 (2.1-22.3) years], respectively. Eleven cases were in premenarcheal period during interrogation. The median age at the time of interrogation of the cases in the premenarcheal period was 11 (4.0-13.4) years. Although we did not discriminate between two age groups as over-conserving surgery and unilateral oophorectomy cases, metrorrhagic, dysmenorrhea and oligomenorrhea were found to be statistically significant in the over-conservative surgery group, although there was no significant difference between menarche ages. No underlying malignancy was detected in any of the overt torsions. The most common underlying cause was ovarian cysts in premenarchal (45.4%), whereas in postmenarchal cases, torsions were most common without underlying lesions (36.4%). There was no difference in pregnancy success between oophoropexy and non-oophoropexy cases. When we evaluated the cases in the over cysts in two groups, unroofing was applied to 63.2% of the cases in our series. There were no significant differences between the two groups in the rates of ipsilateral recurrence and asynchronous contralateral cysts, menstrual features, successful pregnancy rates and blood hormone profiles. In ovarian mass cases, over-conservative surgery was applied to 72.2% of the cases. Of the 72 benign ovarian masses, 39 (54.2%) were mature cystic teratomas. In MCT, asynchronous metachronous mass was found in 5.1% and ipsilateral recurrent mass in 5.1%. In 13 mucinous cystadenoma cases, ipsilateral recurrent mass was detected in 3 (23.1%) cases. It was found that 76.9% of the malignant masses were malignant germ cell neoplasms. When we examined the menstrual characteristics of the cases with over-masses, we found that metrorrhagia and dysmenorrhea complaints were significantly higher in the over-conservative surgery group. There were no significant differences in pregnancy history and blood hormone levels of the cases. There was no significant difference in the rates of ipsilateral recurrence and asynchronous metachronous teratom between overprotective surgery and oophorectomy in mature cystic teratomas. When we evaluated all the cases in two groups according to the exploration scheme, the laparoscopy group was found to have significantly more dysmenorrhea complaints than laparotomies. There were no significant differences between blood hormone levels, premature ovarian failure rate and pregnancy history. In conclusion, oophorectomy cases are not affected by ovarian function and fertility, ovulation problems of detorsion cases were statistically significantly higher than oophorectomy group. there was no significant difference in fertility according to the group without fixation, although the risk of contralateral torsion was proportionally higher in oophorectomized patients due to torsion. There was no statistically significant difference from the detorsion group, over torsions are less likely to detect malignancy as the underlying cause. The surgical technique applied in cysts does not affect the ovulation problems. The surgical technique applied in cysts does not affect fertility. There was no significant difference in fertility between oopherectomy and over-conservative surgery performed in ovarian masses. The likelihood of a contralateral similar mass in oophorectomized patients due to mature cystic teratoma is not higher than that of over protective surgery group. Laparoscopy and laparotomy were not significantly different in the fertility of the cases.