Laparoscopic treatment of benign ovarian mass in children and adolescents

Abstract

Introduction. Laparoscopic treatment for benign ovarian mass in adult patients are widely used and are considered as a standard treatment. At the same time, the use of laparoscopic technologies in ovarian cysts and benign tumors in pediatric patients is limited and in the literature there are presented a small series of cases. Aim of the study. To assess the imminent results of laparoscopic treatment of ovarian mass in pediatric patients. Materials and methods. Database analysis (n=86) with cysts and ovarian tumors in pediatric patients, selected for surgical treatment using laparoscopic technologies from 2000 to 2017. For diagnostics were used ultrasonography, computed tomography and magnetic resonance imaging. Results. The average age of patients was 15.9±0.2 years (95% CI:15.54-16.39), including 5(5.8%) - premenarha and primary amenorrhea (Mayer-Rokitansky-Küster-Hauser syndrome) - 1(1.2%). The Body Mass Index was 21.9±0.4 kg/m2 (95% CI:21.21-22.68). Ovarian mass (n=91) were located: from the right - 42(48.8%), from the left - 39(45.4%) and from both sides - 5(5.8%). Based on radiological data, ovarian cyst/tumor were characterized: max. size - 8.3±0.4 cm, large (> 8 cm) - 38(44.2%) and giant (> 15 cm) - 4(4.7%); "morphological" index after Jeoung HY. - 3.6±0.2 (from 1 to 9). In 9(10.5%) cases laparoscopic interventions were performed for adnexal torsion. For laparoscopic treatment were used two variants: intracorporeal interventions (I gr., n=65) and extracorporeal cyst-(tumor-) ectomy (II gr., n=21). There were performed: cyst -(tumor-)ectomy with ovarian tissue preserving - 85(93.4%), anexectomy - 4(4.4%), cyst -(tumor-)ectomy + tubectomy - 1(1.1%), ovarectomy 1(1.1%) and contralateral ovary diathermocoagulation - 10(11.8%). Mean operation time was 29.3±1.1 min (95% CI:27.07-31.48), in gr. I this index was slightly lower than in gr. II - 27.9±1.1 min. (95% CI:25.79-30.18) vs. 33.1±2.6 min (95% CI:27.15-39.04), the difference is not statistically significant (NS). Intraoperative hemorrhage was 62.5±2.9 ml (95% CI:56.48-68.41), in gr. I this index is lower compared to gr. II - 59.6±2.8 ml (95% CI:53.98-65.28) vs. 70.8±8.3 ml (95% CI:53.40-88.12), the difference is not significant (NS). The morphological examination revealed: ovarian cysts - 57(62.6%) and benign tumors - 34(37.4%). Complications in the postoperative period were not found, average hospitalization - 4.5±0.2 days. Conclusions. The results of laparoscopic surgery in case of benign ovarian mass in children and adolescents are comparable to mini invasive interventions in adult patients. In the case of large and giant ovarian mass it is rational to combine laparoscopy with extracorporeal cyst-(tumor-) ectomy.