Does prevention of intraperitoneal spillage when removing a dermoid cyst prevent granulomatous peritonitis?

Abstract

In this retrospective study of 314 patients undergoing surgery for ovarian dermoid cysts, conducted over a 20-year period, we evaluated the impact of the routine use of laparoscopic surgery without recourse to laparotomy to retrieve the specimen, using an endoscopic retrieval bag placed under the cyst to prevent intraperitoneal spillage of cyst contents, and subsequent postoperative granulomatous peritonitis. Accidental cyst rupture was more frequent when a total laparoscopic approach was used (26/174 or 15% versus 39/140 or 28%; P = 0.005), but there were no cases of intraperitoneal spillage when an endoscopic bag was used. Two cases of granulomatous peritonitis developed out of 26 women with intraperitoneal spillage of cyst contents (8%). We conclude that the risk of granulomatous peritonitis can be minimised by undertaking laparoscopic removal of dermoid cysts with the routine intraoperative use of an endoscopic retrieval bag to prevent intraperitoneal spillage of cyst contents.

Management of the Adnexal Mass

“…In the setting of mature cystic teratoma, intraperitoneal leakage of sebaceous material may result in a dramatic chemical peritonitis. 75,76 Although it is clear that these events are rare among the population of women harboring a benign adnexal mass, the true risk for torsion and spontaneous rupture attributable to an adnexal mass is unknown because the true population prevalence of adnexal masses is unknown. However, in the case of ovarian dermoid, the reported 15-28% rate of iatrogenic intraoperative rupture and potential associated peritonitis reported in the literature arguably far exceeds the risk for spontaneous rupture.…”

“…However, in the case of ovarian dermoid, the reported 15-28% rate of iatrogenic intraoperative rupture and potential associated peritonitis reported in the literature arguably far exceeds the risk for spontaneous rupture. 76 Whereas benign epithelial neoplasms do not appear to increase risk for epithelial ovarian carcinoma, mature cystic teratoma and endometriosis are benign entities that are associated with an increased risk for subsequent malignancy. Malignancy is reported in 0.17-1% of patients undergoing surgery for these conditions [77][78][79] ; however, the true risk for malignant transformation among the population of women with these conditions is again unknown, as is the overall impact of surgical excision for preventive purposes in this setting.…”

Comment je traite… un endométriome par cœlioscopie ?

“…Chaque type de kyste ovarien nécessite une approche chirurgicale différente et adaptée à sa nature [1]. L'endomé-triome en est le meilleur exemple : il est constitué de trois zones distinctes ( Fig.…”

Comment je fais… le traitement cœlioscopique d’un kyste dermoïde de l’ovaire ?

“…La kystectomie intrapéritonéale par coelioscopie est la méthode de référence du traitement des kystes bénins de l'ovaire [1][2]. La technique coelioscopique doit s'adapter à la probable nature du kyste et à son mécanisme de formation.…”

“…L'objectif principal est de ne pas rompre le kyste tout en préservant le tissu ovarien normal. En effet, la rupture d'un kyste dermoïde en péritoine libre expose à la survenue d'une péritonite chimique et à la formation d'adhérences postopératoires [1][2][3][4].…”