Abstract

Hodgkin's disease was diagnosed in two girls aged 11 and 15 years, in stages IIIB and IIIA, respectively. Because of localizations in the para-aortic and para-iliac lymph nodes, irradiation of these lymph nodes was considered necessary; this would result in loss of the ovarian function. Transposition of the ovaries was performed by laparoscopy; in the first patient both ovaries were fixed behind the uterus to the midline, in the second the right ovary was fixed at the level of the right iliac crest and the left ovary to the pelvic wall in the cranial direction. Subsequently, the planned irradiation was carried out. In the first patient, the menarche started at the age of 13, in the second, the menstrual cycle returned to normal. In girls and young women needing irradiation of the pelvis, ovarian function may be preserved by transposition of the ovaries in a high-lateral direction, to the level of the iliac crest. If the irradiation has to include the region of para-iliac lymph nodes, as in patients with Hodgkin's disease in stage III, fixation of the adnexa in the midline at a low level behind the uterus may also be considered. Both interventions are possible by laparoscopy. The disadvantage of the midline oophoropexy is that relatively much scattered radiation can reach the ovary in spite of shielding of the median area; the advantage is that a natural form of conception remains possible (tubal function is preserved).