Laparoscopic management of benign adnexal masses: experience in a developing country

Abstract

Objective To compare the efficacy, cost‐effectiveness, and possible complications of operative laparoscopy with laparotomy for treating benign adnexal cystic tumours at a unit in a developing country. Design A prospective comparative study. Setting Gynaecologic Endoscopy Unit, Assiut University Hospital, Assiut, Egypt. Subjects 91 women of childbearing age with a clinical, biochemical and transvaginal sonographic diagnosis of benign adnexal cystic tumour. Interventions 71 patients were allocated to one of two groups according to management approach. The laparoscopy group (A) included 37 patients while the laparotomy group (B) included 34 patients. Main outcome measures For each patient, the operating time, intra‐ and postoperative complications, postoperative pain and duration of hospital stay were recorded. Results The operating time was significantly shorter in group A (47.8 ± 28.3 min) than in group B (64.9 ± 19.2 min). Intraoperative uncontrolled bleeding occurred in one patient in group A. Postoperative pain was significantly less in group A than in group B (P < 0.001). Postoperative febrile morbidity developed in 12.2% and 31.6% of patients in groups A and B, respectively. The duration of postoperative hospital stay was significantly shorter among patients in group A (49.5 ± 42.6 h) than in group B (124.8 ± 40.9 h) (P < 0.001). Postoperative complications included wound infections: one case in group A and three in group B. Conclusions Laparoscopic management of benign cystic adnexal masses is a fast and safe procedure with minimal intra‐ and postoperative complications compared with laparotomy. Its use in developing countries with limited resources is cost‐effective, given appropriate selection of cases and experienced endoscopists.

Laparoscopy versus laparotomy for benign ovarian tumor: a systematic review and meta-analysis

“…Twenty‐three studies, which compared laparoscopy and laparotomy for benign ovarian tumors, were initially selected. Seventeen of these trials were excluded because they were not randomized (13–29) . Only six RCTs published between 1995 and 1998 met the inclusion criteria for this review with a combined total of 324 women participants (30–35) (Fig.…”

Is there a role for hysteroscopic tubal occlusion of functionless hydrosalpinges prior to IVF/ICSI in modern practice?

“…We noticed poor acceptability of our patients to the salpingectomy decision as it is thought to have a poor impact on their psychological status. Ovarian function seems to be impaired after laparoscopic unilateral salpingectomy in terms of impaired ovarian blood flow and reduced antral follicle count at short‐term assessment (15).…”

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“…We cannot fail to remember all the benefits that this type of surgery has for patients: less pain, less hospital stay, quick recovery; but it also has to do with the experience of the surgeon and the work team (16)(17)(18).…”