Objective: This study was undertaken to examine surgical management of patients with ovarian remnant syndrome. Study design: Data were abstracted from records of patients with a history of bilateral salpingo-oophorectomy who were treated surgically at Mayo Clinic between 1985 and 2003 for pathologically confirmed residual ovarian tissue. A follow-up questionnaire was also mailed. Results: Records review identified 186 patients (mean age, 37.6 years; mean follow-up, 1.2 years). Of 180 patients with available data, 153 (85% ) underwent oophorectomy by laparotomy, 13 (7% ) by laparoscopy, and 14 (8% ) by transvaginal approach, mostly for endometriosis (56.8% ). Of 186 patients, 105 (57% ) presented with pelvic masses and 89 (48% ) with pelvic pain. Remnant ovarian tissue was associated with a corpus luteum in 78 (42% ) and endometriosis in 54 (29% ). The intraoperative complication rate was 9.6% . Of 142 patients, 12 (9% ) required subsequent re-exploration (1 ovarian remnant identified). Conclusion: This heavily pretreated population has modest risk of bowel, bladder, or ureteral trauma with definitive pelvic sidewall stripping and apical vaginal excision. However, subsequent recurrence is minimal ( < 1% ). More than 90% of patients reported resolution or marked improvement of symptoms. Objective: This study was undertaken to examine surgical management of patients with ovarian remnant syndrome. Study design: Data were abstracted from records of patients with a history of bilateral salpingo-oophorectomy who were treated surgically at Mayo Clinic between 1985 and 2003 for pathologically confirmed residual Outcomes identified 186 patients (mean age, 37.6 years; mean follow-up, 1.2 years). Of 180 patients with available data, 153 (85%) underwent oophorectomy by Of 186 patients, 105 (57%) presented with pelvic masses and 89 (48%) with pelvic pain (laparotomy, 13 (7% Of 142 patients, 12 (9%) required subsequent re-exploration (1 ovarian remnant identified). Conclusion: This heavily pretreated population has modest risk of bowel, bladder, or ureteral trauma with definitive pelvic wall stripping and apical vaginal excision. However, subsequent recurrence is minimal (<1%). More than 90% of patients reported resolution or marked improvement of symptoms