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Archives of Women's Health & Gynecology Archives of Women’s Health & Gynecology doi: 10.39127/ AWHG:10001 05 Ahmed NMM. Arch Women Heal Gyn: 105. Research Article Laparoscopy Versus Laparotomy in Management of Benign Adnexal Swellings in Premenopausal Patients: A Prospective Control Study Nagy M. Metwally Ahmed* Obstetrics and Gynecology Department, Faculty of Medicine; Zagazig University. Zagazig, Egypt *Corresponding author: Nagy M. Metwally Ahmed, Lecturer of Obstetrics and Gynecology, Obstetrics and Gynecology Department, Faculty of Medicine; Zagazig University. Zagazig, Egypt. Citation: Ahmed NMM (2018) Laparoscopy Versus Laparotomy in Management of Benign Adnexal Swellings in Premenopausal Patients: A Prospective Control Study. Arch Women Heal Gyn: 105. Received Date: 05 November, 2018; Accepted Date: 11 November, 2018; Published Date: 18 November, 2018 Abstract The main complaint was infertility (45%; 35% primary infertility and 10% secondary infertility), chronic pelvic Laparoscopic removal of ovarian masses is well established pain (30%) and menstrual irregularities (10%) in procedure, but controversy exists regarding the selection of comparison to laparotomy (30% primary infertility), ovarian masses, that can be removed by Laparoscopy. For chronic pelvic pain (35%) and menstrual irregularities this reason, preoperative work-up is needed to offer a (25%). reasonable degree of accuracy in evaluating the ovarian cysts. Preoperative diagnosis includes careful history Ultrasonographic specificity was 87.5% in diagnosis of the taking, clinical examination, ultrasonographic scanning and benign of ovarian masses. Prediction of benign nature of measurement of CA125. ovarian cyst by laparoscopy had sestivity of 100% and negative predictive value of 100%. This study was carried out in the Department of Obstetrics and Gynecology Hospitals from August 2016 to August In laparoscopy group A The diameter of the cyst (mean ± 2017 and was aiming to compare laparoscopy with SD) was 7.1 ± 2.2 cm. The mean operating time was 55.1 ± laparotomy in the management of benign ovarian cysts. 14 minutes, the longest operative time was that of ovarian dermoid cystectomy (73.6 ± 25.5 minutes) due to specimen It included 120 patients recruited from the Outpatient retrieval from pelvic cavity.while in laparotomy group B Clinic of Obstetrics and Gynecology with evident diagnosis The diameter of the cyst (mean ± SD) was6.7 ±1.7 cm. The of benign ovarian cysts. The studied patients included cases mean operative time was 62.o± 12.7 minutes p value having cysts with size 15 cm, smooth borders, no o.112(NS). septa>3mm and no solid parts>25%. There was no significant relation between the diameter of Patients were appropriately prepared. Diagnostic cyst and length of operative time, also no significant laparoscopy was first performed confirming the benign relation between the duration of operative time and nature of the mass and excluding other factors that may severity of pain in 1st 24 hours, postoperative recovery or affect the safety of the procedure, then operative part was hospital stay. Only one intraoperative complication done including ovarian total cystectomy (42 cases), partial occurred (bleeding from a bed of endometriotic cyst after cystectomy (12 cases) and oophorectomy (6 cases). In its removal). In laparoscopy group A Postoperative febrile comparison to laparotomy 39 cases had toatal or 9 cases morbidity was low 10% of versus 25% in laparotomy had partial ovarian cystectomy, oophorectomy 12 cases. patient. Postoperative pain was found early (within 24 Histopathological examination of the cyst wall was done in hours) in 60% of cases and late (within days) in 40% of all cases all proved to be beingn. cases. In laparoscopy groyp A The mean age (± SD) was (24,7 ± In laparoscopy group A Patient recovered significantly 4.9) years. 70% of patients were nullipara and 30% were quickly, resumed oral feeding after 8.3 ± 1.7 hours, got up multiparous women. 3cases (5%) had previous independently after 9.7 ± 2.5 hours, full mobilization after surgery.while in laparotom B group The mean age (± SD) 7.7 ± 2.5 days and can perform their domestic work after was (31 ± 8.1) years. 60% of patients were nullipara and 10.3 ± 2 days.while in laparotomy group resumed oral 40% were multiparous women. Two cases 10%) had intake after 14.7± 4 hours, got up after (16.2±2.7 hours). previous surgery. only twinty precent had resumed sexual activity within two weeks. Arch Women Heal Gyn: 2018 ; Issue 3 Page:1|9 Citation: Ahmed NMM (2018) Laparoscopy Versus Laparotomy in Management of Benign Adnexal Swellings in Premenopausal Patients: A Prospective Control Study. Arch Women Heal Gyn: 105. The duration of postoperative hospital stay was short (29 ± Ahmed et al. (2004) have limited Laparoscopic surgery to 7.9 hours). One case of postoperative complication that was women with an adnexal mass size more than 10 cm hypotension that was managed by IV fluids. Only one cases apparently benign ovarian cyst. was converted to laparotomy and it was discarded from the study. No cyst recurrence was observed in a period of U/S In preoperative selection of candidates for laparoscopic follow-up for 3 months. approach to an adnexal cystic mass, every effort should be exerted in order to rule out malignancy (5). Sonography Conclusion was the most frequent imaging technique used to evaluate benign ovarain cyst, followed by computed tomography The role of operative Laparoscopy has become a gold and magnetic resonance imaging, laboratory testing and standerd for the treatment of many benign gynaecologic CA-125 in particular, can be useful in postmenopausal condition offering distinct advantages of low morbidity, women. In patients of reproductive age, however, the high improved postoperative recovery. False - positive rate of CA-125 renders this test less clinically useful [6]. Operative laparoscopy for evaluation and management of adnexal masses when performed by surgeon trained in Among the different imaging techniques available today, advanced laparoscopic techniques is safe and effective and Transvaginal Sonography (TvS) is the most cost effective, associated with less morbidity compared with open both in postmenopausal and premenopausal women. technique. Various sonographic scoring systems have been developed in order to suggest preoperatively the benign or malignant Introduction nature of adnexal mass [7]. Adnexal masses are frequently found in premenopausal In fact, the transabdominal sonography may miss women aged (18 y -40y). Benign neoplastic masses in the intracystic vegetations due to its limits in resolution power, ovaries include dermoid cysts (mature cystic teratomas), whereas TvS may miss small vegetations, either because endometriomas, and epithelial ovarin cysts, usually serous, they are too small for resolution power of transducer or rarely mucinous. Neoplastic processes in the ovary do not because the cyst evaluated is so large that the vegetations, regress, and therefore, should be treated surgically ether by if located at the pole distal to vaginal fornix, are too far from laparoscopy or laparotomy. The process of patient the probe to be detected [8]. selection always starts with a careful history taking and thorough clinical examination, followed by measurement of Aim of the work CA125 and ultrasound scanning [1]. The aim of this study is to compare the safety, the efficacy, Operative laparoscopy of ovarian cyst is now a method of the operative and postoperative courses of laparoscopic choice due to its advantages, most of which focus on management of benign adnexal swellings to their preserving ovarian tissue and minimizing postoperative management via conventional surgery, regarding; the adhesions formation in reproductive age women [2]. operating time, intra-operative complications, postoperative febrile morbidity, pain, complications, Laparoscopy is a hybrid surgical approach that shares recovery and postoperative hospital stay. characteristics of both minor and major surgery. To patients, laparoscopic procedures often seem to be minor Patients and methods surgery because of the small incisions, relatively small This study is a prospective control study was conducted amount of postoperative pain, and short convalescent throughout the period from Augest 2016 to Augest 2017. It period. When a laparoscopic procedure involves minimal included 120 attendant of Gynecology outpatient clinic intra-abdominal surgery (eg, diagnostic laparoscopy, tubal with a diagnosis of ovarian cysts. fulguration), both postoperative discomfort and the risk of complications may more closely resemble a minor Inclusion criteria procedure than a major procedure [3]. • The patient should be non-pregnant premenopausal Laparoscopic procedures have unique risks, which are women aged from (18 years-40 years old) with history related to methods used for the placement of abdominal sugesstive adnexal mass that was confirmed by TVS wall ports and to the pneumoperitoneum required for scanning to determine the charcateric of the lesion was laparoscopy. The use of energy within the abdominal cavity included. likewise introduces risk. These risks include injury to • Clinical: Mass is cystic, mobile, unilateral, no bowel, bladder, or major blood vessels and intravascular tenderness or evidence of malignancy (fixity, hard insufflation. In addition, increased intra-abdominal consistency or ascites). pressures associated with laparoscopy increase • Ultrasonographic: Reliable pelviabdominal ultrasound anesthesia-related risks such as aspiration
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