Benefits, Drawbacks and Precautions of Performing Laparoscopy and Laparotomy in Management of Benign Adnexal Masses in Pregnant Women; A Comparative Study

Abstract

Surgical management strategies of benign ovarian cysts diagnosed during pregnancy include cyst resection, ovarian excision, or salpingo-oophrectomy but the best surgical procedure is still controversial. Using laparoscopic assisted methods has been extensively used in management of many gynecologic related diseases in non-pregnant women. Previously, performing laparoscopic surgeries for management of benign ovarian cysts during pregnancy was limited to only case reports, case series and retrospective studies. Aim of the study was to compare between laparoscopic and conventional open surgery for management of benign adnexal cysts in pregnant women, regarding; pregnancy outcome, benefits and drawbacks on mother and fetus, operative and perioperative details. Patients and methods We included 80 pregnant females with benign ovarian cysts who were eligible for the study, splitting them in to 2 cohorts each group contain 40 patients the first cohort underwent laparoscopic excision of the ovarian cyst and the second cohort underwent conventional laparotomy for management of the ovarian cysts. Results We found statistically significant differences between both studied groups regarding the overall costs of the operation as; anesthesia, surgery, and materials costs and in comparison with laparotomy, the laparoscopy related costs associated were higher (p < 0.001). We found that duration of post-operative hospital staying was shorter in laparoscopy group than laparotomy group (p < 0.001). The rate and duration of antibiotic prophylaxis was lower in laparoscopy group than laparotomy group (p < 0.001). The rate of wound healing was higher in the laparoscopy group. The postoperative fever rate and degree of maximum temperature was less in laparoscopy group than laparotomy group (p = 0.005). Conclusion We concluded that performing laparoscopic assisted surgical procedure for excision of benign ovarian cystic masses in pregnant women lead to less blood loss, shorter hospitalization better wound healing with no increased risks of fetal or maternal complications than laparotomy. Although laparoscopy has higher costs but it was more accepted by the patients as it is minimally invasive.