Laparoscopy in elective and emergency management of ovarian pathology in children and adolescents.

Abstract

IntroductionOvaries are one of the most common locations of tumor masses in children. Some of them require surgery due to the risk of malignancy or necrosis. This organ seems to be ideal for the laparoscopic approach.AimTo evaluate the usefulness of laparoscopy in surgery of lesions located in the ovaries in patients under 18 years of age and assess the risk of changes in the ovaries in girls with acute abdominal symptoms.Material and methodsRetrospective evaluation of hospital records of the period 1996–2012 from a single hospital was performed. 105 laparoscopic procedures of ovarian pathology in patients aged 0–18 (mean: 13.5) years were reviewed. The overall sample was divided into groups depending on the indication and mode of surgery. Group I: elective or emergency surgery, imaging findings of ovarian cysts bigger than 5 cm or causing pain. Group II: elective surgery, the ovarian tumor visible in imaging (solid mass or mixed). Group III: treatment for acute abdomen, without visible ovarian pathology in the preoperative imaging studies. Group IV: elective treatment of other indications, incidental finding.ResultsThere were no deaths or major complications. There were no conversions. Average length of hospital stay after surgery was 2.5 days. The risk of appendicitis in patients referred for surgery due to ovarian cysts visualized in ultrasound, in the factual absence of ovarian pathology (false positive ultrasound), in the presented material was 5.2%. The risk of lesions in the ovaries in patients operated on due to acute abdominal pain, with no findings in the pre-operative ultrasound (false negative ultrasound), in the presented material was 7.4%. The risk of coexistence of changes in the ovaries with appendicitis found during the procedure due to acute abdominal pain in the study group was 6%.ConclusionsThe laparoscopic treatment for ovarian masses is safe and efficient. The risk of wrong preoperative diagnosis (ovary mass vs. appendicitis) is in any direction between 5 and 8%, which is a number large enough to be taken into consideration when surgical training and legislation is concerned.

Laparoscopic approach to ovarian masses

“…Çocuklarda görülen over kitleleri daha çok benin, kistik lezyonlar olup, sıklıkla yenidoğan, infant ve prepubertal dönemdeki kız çocukla-rında ortaya çıkar. Ender olarak malin patolojiler de görülebilmektedir (1)(2)(3)(4)(5)7) .…”

“…Bunların % 60-70'i over kaynaklı olup, çoğunlukla basit kistlerdir ve % 97'si benindir (1)(2)(3)(4) . Over kitleleri benin ve malin kitleler olarak kabaca ikiye ayrılır.…”

“…Benin kitleler arasında folikül kisti, korpus luteum kisti gibi disfonksiyonel kistler, seröz-müsinöz kistadenom gibi benin epitelyal neoplastik kistler, fibroma, tekoma gibi benin solid tümör-ler, paraovarian kistler ve tubo-ovarian abseler akla gelir. Malin kitleler ise epitelyal, germ hücreleri ve sex-cord stromal kaynaklı tümörlerdir (1,2,(4)(5)(6)(7) .…”

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ÖzAdneksiyal kitleler, çocukluk çağında görülen kitlelerin [1][2]

GirişAdneksial kitleler, çocukluk çağında görülen kitlelerin %1-2'sini oluşturur. Bunların % 60-70'i over kaynaklı olup, çoğunlukla basit kistlerdir ve % 97'si benindir (1)(2)(3)(4) .

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“…Benin kitleler arasında folikül kisti, korpus luteum kisti gibi disfonksiyonel kistler, seröz-müsinöz kistadenom gibi benin epitelyal neoplastik kistler, fibroma, tekoma gibi benin solid tümör-ler, paraovarian kistler ve tubo-ovarian abseler akla gelir. Malin kitleler ise epitelyal, germ hücreleri ve sex-cord stromal kaynaklı tümörlerdir (1,2,(4)(5)(6)(7) .Minimal invazif cerrahi, günümüzde yaygın olarak uygulanan, robotik cerrahinin de gelişmesi ile geleceğin cerrahisi olma yolunda büyük ilerleme kaydeden cerrahi yaklaşımdır. Geçmişte, jinekolojide laparoskopi, tanısal amaçlı ve tüp ligasyonu ile sınırlıyken, günümüzde laparoskopik minimal invazif girişimler-deki ilerlemeye paralel olarak jinekolojide de kullanı-mı ve girişim çeşidi artmıştır.…”