Study objectiveOvarian torsion (OT) in pediatric age is a challenging condition to diagnose and treat. To date, there is still no clear consensus about its management. Our aim was to assess some possible associated factors that can help surgeons in decision-making.DesignWe conducted a retrospective multicentric study of pediatric OT surgically treated between 2010 and 2020 in six Italian and German institutions, comparing our findings with a literature review of the last 10 years (2010–2020).ParticipantsPatients aged 0–18 years with a diagnosis of OT intraoperatively confirmed and surgically treated at the involved institutions.ResultsNinety-seven patients with a mean age at diagnosis of 8.37 years were enrolled in the study. Severe abdominal pain was present in 82 patients (84.5%). Eighty children (82.5%) presented an enlarged ovary with an US diameter > 5 cm and only 32 (40%) of them underwent conservative surgery. A laparoscopic approach was performed in 60 cases (61.9%) although in 15 (15.5%) conversion to open surgery was deemed necessary. A functional cyst was present in 49 patients (50.5%) while 11 children (11.3%) suffered from OT on a normal ovary.ConclusionsOur results showed that a post-menarchal age (p= .001), a pre-operative US ovarian size < 5 cm, (p= .001), the presence of severe abdominal pain (p= .002), a laparoscopic approach (p< .001), and the presence of a functional cyst (p= .002) were significantly associated with conservative surgery.