Adolescent Gynecological Surgeries: Cause for Concern

Abstract

Introduction Gynecological surgery in adolescent girls (10–19 years) remains challenging due to remarkable differences in anatomy, physiology and need for fertility preserving conservative surgical approach. We aimed to identify the various gynecological causes, operative outcomes, and need for follow-up surgeries in adolescents. Methods A single-center hospital record-based retrospective study was conducted for gynecological surgeries performed on adolescents in a 5-year period with exclusion of obstetrical and nongynecological causes. Results Sixty-eight adolescents of mean age 16.77 ± 2.317 years underwent gynecological procedures wherein 63 (92.64%) were postmenarchal girls. Pain abdomen (75%), menstrual abnormality (47%), and abdominal swelling (47%) were their main complaints. Note that 35 (51.4%) surgeries performed were for adnexal masses and 24 (35.3%) for obstructive Mullerian anomalies or neovagina creation. Other indicated surgeries were uterine leiomyoma (4.4%), Bartholin's cyst (5.8%), and pelvic abscess (1.4%). The mean interval of symptoms to the diagnosis was 1.22 ± 1.381 years while the mean diagnosis to surgery interval was 8.71 ± 5.880 days. A statistically significant difference (243.3 vs. 783.1 days, p < 0.00001) was found in the symptoms to diagnosis interval and the length of hospital stay (difference in means 16 days, p < 0.00001) in the two major operative groups. Minimal access surgery could be completed in 37% of cases. Complications encountered were bowel injury in 5.8%, bladder injury in 2.9%, blood transfusion requirement in 5.8%, and reoperation in 2.94%. Follow-up revealed one death, adjuvant chemotherapy in 7.3%, and suppressive hormone therapy for endometriosis in 13% of operated girls. Conclusion Diagnosis of a gynecological presentation is protracted and delayed in adolescents. Both diagnosis and surgery is challenging, and minimal invasive surgery is preferable. Malignancy diagnosis or exclusion, treatment, and follow-up should be prioritized to limit delays in the decision to treat. Timely and appropriate, as far as possible conservative surgery and adherence to follow-up protocols will ensure successful outcomes.