Comparison of protective effect of gradual detorsion and hypothermia in ovarian ischemia-reperfusion injury

Ovarian torsion is the fifth most common gynecological emergency in girls and adolescents. Today, ovarian detorsion is the treatment of ovarian torsion and ovary is tried to be protected as much as possible. Duration passed after torsion is important to prevent ovarian loss. Early diagnosis and timely surgical intervention are necessary to maintain fertility. If the torsioned ovary is detorsed before any infarction develops, normal blood flow can be recovered. However, following detorsion, reperfusion injury caused by high amounts of oxygen-derived free radicals causes more tissue damage than initial ischemia. Reperfusion injury plays a major role in ovarian torsion for ovarian damage. Various mechanisms have been described to prevent tissue damage during ischemia-reperfusion. In this experimental study, we aimed to show the effect of gradual detorsion and hypothermia on ischemia reperfusion injury in a rat model of ovarian torsion-detorsion. In this study, 40 adult Wistar female rats were used. Groups were numbered as Group I (sham group), Group II (control group) and Group III (gradual detorsion), Group IV (hypothermia), Group V (gradual detorsion + hypothermia). After the approval of the ethics committee, by intramuscular injection, 50 mg / kg ketamine and 3 mg / kg xylazine were used for anesthesia. After laparotomy was performed on the rats in Group I, the left ovary was removed and the abdomen was closed without any other procedure. The right ovary was removed 30 hours later. The rats in Group II-III-IV-V were subjected to laparotomy after the left ovary was removed and the right ovary was torsioned by 1080 degrees. The right ovary was left ischemic for 30 hours. After laparotomy, full detorsion was performed in Group II and the reperfusion was achieved. In Group III, the right ovary was performed detorsion 360 degrees and waited for 5 minutes and this procedure was repeated 3 times until the right ovary was became completely detorsed and then the abdomen was closed. In Group IV, cold application was performed for a total of twenty minutes at the beginning and after the full detorsion of the right ovary. In Group II-III-IV-V, abdomens were closed for one week and the laparotomy was performed again in order to remove the right ovary. After oopherectomy, ovarian tissues were examined histopathologically for vascular occlusion, interstitial edema, bleeding, IV leukocyte infiltration. Superoxide Dismutase (SOD), Myeloperoxidase (MPO), Malondialdehyde (MDA), Catalase (CAT), Glutathione Peroxidase (GPx) values were examined in tissue samples and serum. The results of our study show that gradual detorsion and hypothermia may be effective in reducing both biochemical and histopathological damage due to I / R damage. Key words: Ovary, Torsion, Ischemia-Reperfusion Injury, Hypothermia, Gradual detorsion