Laparoscopic treatment of ovarian dermoid cysts

الملخص

Objectives:
Dermoid cyst which is also known as benign or mature cystic teratoma is a common disease and accounts about 21.8% of all ovarian tumors.They areone of the most common tumors in women during the reproductive yearsand they are not uncommon during pregnancy. They are mostly benign in nature but surgery is needed to relief of symptoms and to prevent complications.
In the recent years, the laparoscopic approach have greatly replaced most of the gynaecological operation and specially in benign ovarian diseases as it improved significantly the outcome of these lesions.
Aim of the study: reviewing the laparoscopic management of ovarian dermoid cysts and assessing the intra-operative complications, and early postoperative follow-up.
Material and MethodA prospective study of 43 patient who underwent laparoscopic management of ovarian dermoid cysts.
The patients are presented either with acute symptoms like pain , vaginal bleeding or chronic symptoms like abdominal pain or menstrual irregularities. This suspicion is documented by pelvic ultrasound . then the patients are qualified for laparoscopic management under general anasthesia.
Results:
A total of 43 women with ovarian dermoid cyst were included and treated laparoscopically . the main age is 31.31 years.Mean cyst diameter size that was measured by ultrasound was 7.24. they are bilateral in 28 % of cases. Patient age and size of cyst did not differ between those with left and right lesions.
Cystectomy with enuculation of the cyst was the most commonly applied procedure , while total adnexectomy and partial oophorectomy was the least frequent.The whole gonad was removed in one postmenopausal patients.
The mean duration of the operation was 53.48 minutes (± 20.61; range 35-120 ).The total number of days in the hospital excluding the period of preoperative examination (generally 1 day) was 2.54 days.All the extracted material was submitted for a final histopathological examination.
Intra-operatively;a minimal spillage occurred in 18 casesand rupture of retrieval bag occurred in 2 cases but none developed post-operative chemical peritonitis.In two cases we discover bleeding from the left ileac fossa 5 mm port .Port site infections were noted in six patient.No case of postoperative peritonitis was recorded. There was one case of post-operative paralytic ileus.
Discussion:
Laparoscopic removal of ovariandermoid cysts has increased in the last few years. But this need aproper early qualification, based on medical history, gynaecological and sonographic examination to assure the benignity of these lesions although malignant transformation of these benign lesion is rare and it is a contra-indication to the laparoscopic treatment.
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Dermoid cysts occur not often during pregnancy, but caused their complications ( high risk of torsion and rupture ) demand immediate surgical intervention
Laparoscopic treatment consist of total cyst excision with preservation of the remaining ovarian tissue but partial oophorectomy or total oophorectomy can be indicated if there is suspected area specially in post-menopausal women .
Laparoscopic treatment of ovarian dermoid cyst may be complicated with port site haemorrhage , intra –peritoneal spillage of the cyst content and post-operative paralytic ileus . these are mostly minimal and can be managed conservatively.
Conclusion:
We concludes that the minimal access surgical treatment through the laparoscopic ovariandermoid cystectomy is a safe and beneficial method in selected patients. It offers the advantages of shorter hospital stay, and better cosmetic result in comparison to classical surgery.