OVARIAN REMNANT SYNDROME AFTER LAPAROSCOPIC HYSTERECTOMY AND BILATERAL SALPINGO-OOPHORECTOMY FOR SEVERE PELVIC ENDOMETRIOSIS

Ovarian remnant syndrome is a rare complication oi total abdominal hys terectomy and bilateral salpingo-oophorectomy (BSO). Ovarian enlargeme nt and dense periovarian adhesions are the predisposing factors. Recur rent ovarian remnant syndrome was associated with recurrence of sympto matic endometriosis in a woman who underwent laparoscopic supracervica l hysterectomy and BSO for severe endometriosis and extensive pelvic a dhesions. After primary surgery she required five additional procedure s for complete resection of all ovarian remnants. Definitive surgery f or advanced endometriosis with extensive periovarian adhesions may be complicated by ovarian remnant syndrome and reactivation of the diseas e. Careful retroperitoneal resection of all ovarian tissue is of param ount importance in preventing the syndrome. This, however, may be a li mitation of laparoscopic surgery. The choice between laparoscopy and l aparotomy in such cases should be individualized and based on the degr ee of surgical difficulty and the surgeon's level of experience.