Ovarian preservation in children for adenexal pathology, current trends in laparoscopic management and our experience

Agarwal, Prakash; Bagdi, Rajkishore; Balagopal, Sundaresan; Ramasundaram, Madhu; Paramaswamy, Balamourougane

doi:10.4103/0971-9261.129594

Cited by 28 publications

(16 citation statements)

References 14 publications

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“…Ovarian-sparing procedures have found precedence, especially since the incidence of bilateral metachronous ovary torsion (OT) is found to be as high as 12%. [ 11 ] In the present analysis, bilateral and unilateral OTs caused as a result of OCMT were found to be 7.4%. In a 9-year-old girl, bilateral torsion was reported, although adnexal torsion occurring in a premenarchal girl is an extremely rare disorder and bilateral adnexal torsion is even a rarer event.…”

Section: Discussionmentioning

confidence: 45%

Review of laparoscopic management of mature cystic teratoma of ovaries in children

Raičević

Saxena

2019

J Indian Assoc Pediatr Surg

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Ovarian cystic mature teratomas (OCMTs) are the most frequent ovarian tumors in childhood. This review aimed to determine the feasibility and safety of laparoscopic management of OCMT. Literature was searched for terms “mature,” “ovarian,” “teratomas,” and “laparoscopy.” Primary endpoints were age at surgery, laparoscopic and surgical technique, intraoperative complications, postoperative morbidity, and associated pathology. Literature search revealed 11 articles published between 1998 and 2014 that met the inclusion criteria. There were 105 (n = 95 unilateral; n = 10 bilateral) patients for this analysis, with mean age at surgery being 13 years. Four laparoscopic approaches were opted: gasless transumbilical laparoendoscopic single-site (LESS) surgery (n = 19), gasless multiport surgery (n = 24), single-incision laparoscopic surgery (SILS) (n = 3), and pneumoperitoneum multiport laparoscopy (n = 59). The 10 patients with bilateral OCMT underwent ovary-sparing surgery: LESS-assisted extracorporeal bilateral cystectomy in which tumors were punctured by a balloon catheter (n = 2), intracorporeal cystectomy for gasless multiport laparoscopy (n = 5) with use of endobags to prevent spillage, and transperitoneal multiport laparoscopy (n = 3). OCMT was associated with ipsilateral and unilateral ovarian torsion in five and bilateral ovarian torsion in one patient with bilateral OCMT. In four patients with unilateral OCMT, salpingo-oophorectomy was performed. Intraoperative complications were laceration of utero-ovarian ligament and bladder injury during a suprapubic port placement. The mean follow-up was 31.9 months. Patients with unilateral or bilateral OCMT can be offered ovarian-sparing surgery laparoscopically with one of the following techniques: LESS, SILS or multiport laparoscopy with pneumoperitoneal or gasless. Long-term follow-up of these techniques has shown no recurrence with low postoperative morbidity and low intraoperative complications.

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Section: Discussionmentioning

confidence: 45%

Review of laparoscopic management of mature cystic teratoma of ovaries in children

Raičević

Saxena

2019

J Indian Assoc Pediatr Surg

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“…Enucleation of paraovarian cyst with ovarian salvage is the standard treatment. 6,7 In present case as this nonpedunculated paraovarian cyst was about 30×25 cm in size in close proximity with right fallopian tube arising in broad ligament cyst was excised with right fallopian removal and right ovary was preserved. Now-adays laparoscopy is being widely used in gynae cases as minimally invasive surgery.…”

Section: Discussionmentioning

confidence: 80%

“…In case of complicated cyst excision of ovary and/or fallopian tube may be required. [5][6][7] regular cycles of 28 days with normal flow for 3-4 days associated with mild dysmenorrhoea. This abdominal discomfort was not aggravated with meal, exertion or any kind of body posture.…”

Section: Introductionmentioning

confidence: 99%

An unusual presentation of huge paraovarian cyst as papillary serous cyst adenofibroma: a rare case report

Agrawal

Gupta

Chandra

et al. 2018

Int J Reprod Contracept Obstet Gynecol

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Paraovarian cysts constitute 10-20% of all adnexal masses and are usually less than two centimeter in diameter. Authors reported a 20-year-old unmarried female with vague abdominal discomfort since 1 year. On examination abdomen was uniformly distended with central position of umbilicus. Ultrasonography showed a large cystic mass extending from pelvis to pancreas likely of ovarian origin. Biochemical evaluation was not suggestive of malignant nature of this cystic mass. So, with due care of cosmesis, surgery was planned. After the midline vertical incision, peritoneal washings were collected for oicytological analysis to further exclude malignancy. Then 5mm cannula with trocar was inserted into the cyst to suck out the fluid then shrunken cystic wall was exteriorised. Right ovary was absolutely healthy. Enucleation of the cyst was done with preservation of ovary. Histopathology reported as a papillary serous cyst adenofibroma. Follow up period was uneventful.

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“…This type of tumour can occur at any age, but is more common during reproductive years, espe-cially in patients under 30 years of age (2). Early diagnosis and operative treatment (cystectomy) in childhood and adolescence are important for the development of normal puberty and future fertility (12). In their study, Zupi et al compared tumour-affected ovaries before and after laparoscopic ovarian cystectomy.…”

Section: Epidemiologymentioning

confidence: 99%

Chemical peritonitis resulting from spontaneous rupture of a mature ovarian cystic teratoma: a case report

Bužinskienė¹,

Mongirdas²,

Mikėnas³

et al. 2020

AML

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Background. Mature cystic teratomas (dermoid cysts) are the most common germ cell tumours with 10–25% incidence of adult and 50% of paediatric ovarian tumours. The aetiology of dermoid cysts is still unclear, although currently the parthenogenic theory is most widely accepted. The tumour is slow-growing and in the majority of cases it is an accidental finding. Presenting symptoms are vague and nonspecific. The main complication of a dermoid cyst is cyst torsion (15%); other reported complications include malignant transformation (1–2%), infection (1%), and rupture (0.3–2%). Prolonged pressure during pregnancy, torsion with infarction, or a direct trauma are the main risk factors for a spontaneous dermoid rupture that can lead to acute or chronic peritonitis. The diagnosis of mature cystic teratoma is often made in retrospect after surgical resection of an ovarian cyst, because such imaging modalities as ultrasound, computer tomography, or magnetic resonance imaging cannot yet accurately and reliably distinguish between benign and malignant pathology. Materials and methods. We present a report of a clinical case of a 35-years-old female, who was referred to the hospital due to abdominal pain spreading to her feet for three successive days. She had a history of a normal vaginal delivery one month before. Abdominal examination revealed mild tenderness in the lower abdomen; no obvious muscle rigidity was noted. Transvaginal ultrasound showed a multiloculated cystic mass measuring 16 × 10 cm in the pelvis. In the absence of urgency, planned surgical treatment was recommended. The next day the patient was referred to the hospital again, with a complaint of stronger abdominal pain (7/10), nausea, and vomiting. This time abdominal examination revealed symptoms of acute peritonitis. The ultrasound scan differed from the previous one. This time, the transvaginal ultrasound scan revealed abnormally changed ovaries bilaterally. There was a large amount of free fluid in the abdominal cavity. The patient was operated on – left laparoscopic cystectomy and right adnexectomy were performed. Postoperative antibacterial treatment, infusion of fluids, painkillers, prophylaxis of the thromboembolism were administered. The patient was discharged from the hospital on the seventh postoperative day and was sent for outpatient observation. Results and conclusions. Ultrasound is the imaging modality of choice for a dermoid cyst because it is safe, non-invasive, and quick to perform. Leakage or spillage of dermoid cyst contents can cause chemical peritonitis, which is an aseptic inflammatory peritoneal reaction. Once a rupture of an ovarian cystic teratoma is diagnosed, immediate surgical intervention with prompt removal of the spontaneously ruptured ovarian cyst and thorough peritoneal lavage are required.

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Ovarian preservation in children for adenexal pathology, current trends in laparoscopic management and our experience

Cited by 28 publications

References 14 publications

Review of laparoscopic management of mature cystic teratoma of ovaries in children

Review of laparoscopic management of mature cystic teratoma of ovaries in children

An unusual presentation of huge paraovarian cyst as papillary serous cyst adenofibroma: a rare case report

Chemical peritonitis resulting from spontaneous rupture of a mature ovarian cystic teratoma: a case report

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