Resection of mesothelial cyst of uterine round ligament by laparoscopic transabdominal preperitoneal procedure alone or combined with open surgery

Abstract

Objective: Surgical treatment of a mesothelial cyst of the uterine round ligament (MCURL), an uncommon entity, has been rarely documented. In this article, we present our experience with excision of MCURLs. Methods: The records of all female patients undergoing surgical removal of a groin mass in our department from March 2013 to November 2018 were retrospectively reviewed. Demographic information, clinical data, and follow-up outcomes were collected and analyzed. Results: Among 298 women who underwent groin hernia repair, 17 (5.7%) had MCURLs. Of these 17 patients, 13 were aged 30 to 45 years and 15 had a normal body mass index (18.5-23.9 kg/m 2 ). MCURLs occurred predominantly on the right side (11/17). Approximately half of the patients (9/17) were preoperatively misdiagnosed with inguinal hernias. Approximately 70% (12/17) of the lesions were localized medially to the inner ring of the inguinal canal and excised by a laparoscopic transabdominal preperitoneal (TAPP) procedure alone. Five patients required open surgery following the TAPP procedure because the cyst extended distally beyond the inner ring. No recurrence was noted during the entire follow-up period. Conclusion: Most MCURLs were localized medially to the inner ring of the inguinal canal and could be excised by a TAPP procedure.

Laparoscopic Inguinal Hernia Repair for Female Patients: Experience from a High-volume Center in 20 years

“…In this study, the incidence of MCURL was 12.9% (74/572). As reported in previous small cohort studies, the incidence of MCURL was 2.2% to 5.7% 21,22 . Chen et al 21 found that MCURL was mostly found in middle-aged women and was more common on the right side.…”

“…As reported in previous small cohort studies, the incidence of MCURL was 2.2% to 5.7%. 21,22 Chen et al 21 found that MCURL was mostly found in middle-aged women and was more common on the right side. In our study, by comparing patients of different ages with MCURL, we found that the incidence of MCURL was correlated with patient age.…”

“…During embryonic development, part of the peritoneum is incorporated into the round ligament; therefore, there is a correlation between the MCURL and weakness of the abdominal wall. 21 Based on this theory, even if an MCURL is found during the operation and no obvious inguinal hernia is found, many surgeons still believe that it is necessary to remove the MCURL and repair the abdominal wall defects. The TAPP can better explore and remove MCURL owing to its larger surgical field and better surgical vision.…”

“…The round ligament is primarily composed of fibrous connective tissue originating from the uterus and extending into the labia majora. During embryonic development, part of the peritoneum is incorporated into the round ligament; therefore, there is a correlation between the MCURL and weakness of the abdominal wall 21 . Based on this theory, even if an MCURL is found during the operation and no obvious inguinal hernia is found, many surgeons still believe that it is necessary to remove the MCURL and repair the abdominal wall defects.…”