Background: Residual Ovary Syndrome (ROS) is the presence of pelvic pain associated with the deliberate retention of one or both ovaries at the time of hysterectomy[1]. With a reported frequency of 0.9-4.9%[2], ROS is a common condition with few conservative options for management. Surgery to treat ROS is technically challenging owing to complex surgical history, adhesions and co-morbidities such as endometriosis[3] and there is currently limited research to guide practice.
Objective: To describe our experience in laparoscopic treatment of ROS, assess the outcome of reported pain at follow up, the risk of surgical complications and ascertain if there were any factors contributing to these outcomes.
Methods: Retrospective analysis of patients undertaking laparoscopic oophorectomy to treat ROS at the Royal Women’s Hospital Gynaecology 2 Unit between January 2008 – May 2017. Patient information was extracted from medical records including demographics, co-morbidities, surgical history and initial imaging performed. We then collected detailed surgical information including level of adhesions, length of stay and complications. Finally histopathology and follow up regarding pain symptoms were recorded.
Results: Ninety-nine patients were included in the analysis with a mean age of 48.9 and average BMI of 28.1. Average operative time was 1 hour and 51 mins and mean length of stay was 1.96 days. There were six major operative complications (6.1%) and two cases required conversion to laparotomy for better access (2%). There were 7 post-operative complications (7.1%). Factors associated with greater risk of complications included high BMI and severe adhesions reported by surgeons.
At follow up, 9% reported persistent pain symptoms, 25% stated their pain had improved but was still present. Factors associated significantly with persistent pain symptoms at follow up were younger age and a history of gastrointestinal illness.No other factors, including a history of endometriosis, were found to be associated with pain at follow up or complications.
Conclusions: Laparoscopic treatment of ROS is challenging, yet may offer improvement in pain symptoms. Groups less likely to show pain improvement are younger women or those with a history of gastro-intestinal illnesses. Patients should be counselled about the significant risk of complications particularly when they have a raised BMI or multiple previous operations, and the operation should be performed by an experienced advanced laparoscopic surgeon.