Adnexal Torsion Recurrence - Is the Adnexal Twist Degree a Risk Factor? A Retrospective Cohort Study.

OBJECTIVE To evaluate whether the adnexal twist degree is related to torsion recurrence and whether there is a dose-dependent relationship. DESIGN A retrospective cohort study SETTING: Single tertiary medical center POPULATION: The study includes non-pregnant patients operated, for the first time, for adnexal torsion, between 2011-2018. METHODS Information regarding the degree of adnexal twist was collected from surgical reports. Recurrence was identified using a computerized database and ascertained via telephone with a response rate of 87.2% (253/290). MAIN OUTCOME MEASURES Adnexal torsion recurrence rate. RESULTS 182 women that underwent laparoscopic detorsion met inclusion criteria. 22 had torsion recurrence (12.1%). Adnexal twist degree in the primary event was associated with a higher recurrence risk: 4.3% of women with twist degree ≤360 (n=3/70), 14.5% of women with twist degree of 361-720 (n=9/62), and 20% of women with twist degree >720 (n=10/50), p=0.03. The median twist degree was 540 (IQR 360-855) degrees and 720 (IQR 675-1080) degrees, in the control and study groups, respectively (p=0.005). Additional possibly associated factors for recurrence were evaluated. Age emerged as a possible risk factor, with a median age of 19 years in the recurrence group (IQR 14-27 years) versus 28.5 (IQR 19-36 years) in the non-recurrence group (p<0.01). Logistic regression analysis revealed that together with age, adnexal twist degree remained significantly associated with torsion recurrence [OR 1.98, 95% CI 1.09-3.61, (p=0.02)]. CONCLUSION Adnexal twist degree was found to be positively associated with the risk of torsion recurrence.