Purpose <p>To compare the effectiveness of ovarian ligament plication and ovario-round ligament fixation ("hot-dog" technique) in preventing recurrent adnexal torsion.</p> Methods <p>This is a retrospective cohort study performed in the gynecology department, of a university-affiliated tertiary medical center. Women of reproductive age who underwent first fixation following adnexal torsion surgery on the ipsilateral side between 2014 and 2023. The study included a homogenous population with normal ovarian size. Primary outcome was the recurrence rate of adnexal torsion following each fixation technique. Two fixation techniques of ovarian ligament plication and ovario-round ligament fixation were compared.</p> Results <p>A total of 525 adnexal torsion events were reviewed, involving 413 patients. After applying strict inclusion criteria, 38 patients who underwent their first fixation on the ipsilateral side were included in the final analysis. Among them, 27 (71%) underwent ovarian ligament plication, and 11 (29%) underwent ovario-round ligament fixation. Recurrent torsion occurred in 25.9% (7 of 27) of patients in the ovarian ligament plication group, while no recurrences were observed in the ovario-round ligament fixation group. While clinically promising, the difference did not reach statistical significance (<i>p</i> = 0.08). Fixation was also safely performed during pregnancy, primarily in the first trimester, with no postoperative complications observed.</p> Conclusions <p>Ovario-round ligament fixation shows promise as a technique for preventing recurrent torsion with a favorable safety profile. Due to the limited sample size, further larger-scale studies are required to confirm these findings and comprehensively evaluate long-term outcomes.</p>