Short- and long-term outcomes of intraoperative spillage during laparoscopic removal of benign ovarian cysts

Short- and Long-Term Complications of Intraoperative Benign Ovarian Cyst Spillage: A Systematic Review and Meta-analysis

“…Benign cyst recurrence after laparotomy or laparoscopy was found to be an infrequent event, with only 13 documented events out of the 616 included cases (2.1%) [18,21,26,28,34,35]. Among patients with intraoperative spillage, the recurrence rate was 3.6% (10/280) vs 0.9% (3/ 336) in patients without spillage.…”

“…The quantitative analysis comprised the remaining 12 studies involving 2742 subjects: one RCT [18] and 11 observational studies [21,22,25,28,32,[34][35][36][37][38]41]. These studies included patients who underwent minimally invasive surgery or laparotomy for presumed or retrospectively known benign ovarian cysts.…”

“…The maximum ovarian cyst diameter was assessed in 4 observational studies [22,25,28,36] and was found to be a significant risk factor for spillage only by Childress et al [25] who evaluated operative outcomes in 106 young patients (aged 1 year to 21 years) who underwent cystectomy (laparotomy/laparoscopy) for an adnexal mass (RR 2.7; 95% CI, 1.28−4.12). Berg et al [22], Nezhat et al [36], and Hizkiyahu et al [28] included only patients who underwent laparoscopy for benign ovarian cysts, and they did not find cyst diameter to be a risk factor for intraoperative spillage. Similarly, our meta-analysis showed no statistical difference between ovarian cyst diameter in patients with intraoperative spillage and ovarian cyst diameter in those without intraoperative spillage (RR 0.75; 95% CI, −0.33 to 1.82).…”

“…Three RCTs [17−19] and 19 observational studies [5,20,22−32,34,36,39−42] evaluated the risk for chemical peritonitis in relation to the intraoperative spillage. Chemical peritonitis was found to be a rare event, with only 6 documented incidents in only 3 retrospective studies [28,32,34] (Fig. 4).…”

“…Among patients with intraoperative spillage, the recurrence rate was 3.6% (10/280) vs 0.9% (3/ 336) in patients without spillage. After excluding studies without events in both arms [18,26], the 4 observational studies that were included in the meta-analysis [21,28,34,35] showed a higher cyst recurrence rate in the group in which the spillage was reported (RR 3.1; 95% CI, 1.05−9.14) ( Fig. 5).…”