Ovarian remnant syndrome managed laparoscopically. (Case Series of 26 Patients).

WINNIPEG, MAN. -- Patients with ovarian remnant syndrome can be effectively treated laparoscopically based on the findings of a 26-patient series

"Ovarian remnant syndrome is a rare occurrence and most surgeons would recommend managing it by laparotomy because you're dealing with extensive adhesions. But our series has shown that it can be done laparoscopically," Dr. Basim Abu-Rafeh said at the annual meeting of the Society of Obstetricians and Gynaecologists of Canada.

In a series of 119 patients with persistent pelvic pain even after hysterectomy and oophorectomy there were 26 patients with ovarian remnant syndrome. This is the largest reported series of patients with the syndrome who were managed laparoscopically, said Dr. Abu-Rafeh, an obstetrics and gynecology resident at the University of Western Ontario in London.

Five of the patients had been previously diagnosed with ovarian remnant syndrome and had undergone at least one laparoscopic attempt to remove the remnants. The remainder had ovarian remnant syndrome diagnosed intraoperatively.

All patients were managed laparoscopically with complete adhesiolysis and/ or excision of all visible endometriosis and scars. Identification and dissection of the ipsilateral ureter was done by incising the peritoneum at the pelvic brim and up to the bladder. Dissection and mobilization of the ovarian remnant was accomplished by a combination of [CO.sub.2] laser, hydrodissection, and electrosurgery. There were no complications or conversions to laparotomy.

At a follow-up of 1-8 years (mean 5 years), 77% of patients were symptom free after the remnant was removed. Six ...