Effects of Intraoperatively Ruptured Ovarian Dermoid Cysts

Abstract

Objective: The most-dreaded complications of dermoid cyst spills are chemical peritonitis, iatrogenic implantation of malignant cells, and recurrences. This study recorded the incidence of chemical peritonitis after dermoid-cyst excision with intraoperative cyst spilling and examined short- and long-term postoperative complications and recurrence rates. Materials and Methods: This retrospective analysis included 72 females who underwent ovarian cystectomies and who had ovarian dermoid cysts excisions from January 2016 to December 2020. Data pertaining to types of procedures, intraoperative cyst ruptures, chemical peritonitis, readmissions, and recurrences were analyzed. Results: Females (72) underwent dermoid-cyst excisions (laparotomy: 12; laparoscopy: 60). The mean age of presentation was 29.3 ± 11 years, mean cyst volume was 488.08 ± 1852.8 cc; 88.9% of cysts ruptured during excision; 0 cases of chemical peritonitis; and 1 patient had a cyst recur 4 months after removal. The laparotomy group, had a higher incidence of raised cancer antigen–125 levels (p < 0.001), torsions (p < 0.05), salpingo-oophorectomies (p < 0.001), estimated blood losses (p < 0.003), and longer operative times (p < 0.002), compared to the laparoscopy group. However, there was no significant difference between the 2 groups in spillages, chemical peritonitis, postoperative complications, and recurrences. In a subgroup analysis of laparoscopy cases, spillage was commonly associated with larger cysts (p < 0.0001), cystectomies (p < 0.0001), and longer operative times (p < 0.06). Conclusions: Intraoperative cyst content spillage does not influence the outcome of dermoid-cyst removal. Hence, laparoscopy is a safe and effective method of managing dermoid cysts. (J GYNECOL SURG 38:221)