Original Study
Laparoscopic Treatment of Ovarian Cysts in Adolescents and Young Adults

https://doi.org/10.1016/j.jpag.2011.05.006Get rights and content

Abstract

Study Objective

To investigate the laparoscopic management of ovarian cysts in adolescents and young adults.

Design

A retrospective chart review study.

Setting

Zekai Tahir Burak Women’s Health Research and Education Hospital.

Participants

A total of 282 females aged 25 years or younger underwent laparoscopic surgery for a presumed benign ovarian cyst. Patients were grouped as adolescents (ages 12–19, n = 79) or young adults (ages 20–25, n = 203).

Main Outcome Measures

Surgical approach, operative findings and the correlation of intraoperative diagnosis with the definitive pathological reports.

Results

The mean age of the patients was 21.2 years. At laparoscopic surgery, 89 patients (31.6%) had endometriomas, 47 (16.7%) had dermoid cysts, and 37 (13.1%) had paraovarian cysts. Ninety-seven patients (34.4%) had simple ovarian cysts. Pathological reports revealed that young adults were more likely to have endometriomas (34.0% vs 7.6%, P < 0.01), but dermoid cysts and simple ovarian cysts were more frequent (20.3% vs 15.3%, P < 0.01 and 60.7% vs 40.9%, P < 0.01, respectively).in adolescents. Eleven of the cases (3.9%) were found to have mucinous cystadenomas and fourteen (5.0%) to have serous cystadenomas. Four cysts were malignant (1.4%). Cystectomy was performed in 205 cases (72.7%), fenestration of cyst wall was performed in 53 cases (18.8%), and aspiration was applied in 22 cases (7.8%). The types of operation were not significantly different among adolescents and young adults (P > 0.05). The operative diagnosis was highly correlated with the final pathological reports (kappa value= 0.901, P < 0.001). There were no operative and postoperative complications in our series.

Conclusion

With a careful preoperative screening, the laparoscopic surgery of ovarian cyst is an efficient and safe treatment for adolescents and young adults.

Introduction

Functional cysts are the most common ovarian lesions among adolescents and young females. In a large case study by Templeman et al,1 majority of the ovarian masses requiring surgery in this age group were ovarian cysts (57.9%), the most common being hemorrhagic corpus luteal cysts. The remaining masses were neoplasms of which 75% were benign. The most common benign ovarian tumor in this age group is mature cystic teratoma.1, 2

Malign ovarian tumors are rare in children and adolescents with only 4.5–16% of cysts being malignant3, 4, 5 and majority of them are germ cell tumors.6

Management of ovarian cysts is dependent on the features of the cysts and the presence of symptoms and surgery may be required to determine the nature of the adnexal mass. In recent years, laparoscopic surgery has been accepted as the gold standard in the management of adnexal masses in gynecologic surgery and its advantages have been well documented in large adult series.7 Also, there has been a notable shift from open surgery to laparoscopic approach in young females.8 Minimally invasive surgery in this age group is especially important for future fertility. However, there are small series describing the efficacy and safety of laparoscopy for ovarian lesions in the adolescent and young adult population.1, 2, 3, 7

The present study tried to investigate the laparoscopic management of ovarian masses in adolescents and young adults and review our experience about this subject.

Section snippets

Materials and Methods

Between January 2008 and December 2010, 282 patients aged 25 years or younger underwent laparoscopic surgery for a presumed benign ovarian mass at Zekai Tahir Burak Women’s Health Research and Education Hospital. Data were abstracted retrospectively from clinical records and included the operative note and final pathologic diagnosis. Records were available for all cases, so no patients were excluded from this study. Permission for this review was obtained from the Institutional Research Ethics

Results

The study population consisted of 79 adolescents and 203 young adults. The mean age of the patients was 21.2 years (range 12–25 years). The median diameter of the cysts was 5 cm (range 2–7 cm). At the laparoscopic surgery, it was observed that 97 (34.4%) patients had simple ovarian cysts, 89 (31.6%) had endometriomas, 47 (16.7%) had dermoid cysts and 37 (13.1%) patients had paraovarian cysts. Twenty patients had bilateral lesions. When we analyzed the groups separately we observed that simple

Discussion

Laparoscopy has become the accepted approach for surgical management of ovarian lesions in the adult population and its value has been demonstrated with earlier studies.10, 11, 12 Laparotomy is now generally reserved for when malignancy is suspected.10 Most contemporary authorities have advocated a conservative approach with laparoscopic surgery with adnexal masses in adolescents and young females.7, 8

Operative laparoscopy in treating an ovarian mass provides advantages such as minimal tissue

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  • Cited by (0)

    We have no potential conflicts of interest to disclose associated with this article.

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