Management of Ovarian Dermoid Cysts in the Pediatric and Adolescent Population

Abstract

Study Objective To evaluate the surgical approach used in the management of ovarian dermoid cysts in the pediatric and adolescent population. Design A descriptive retrospective chart review of all cases of ovarian dermoid cyst excision between January 2001 and January 2006. Setting The Hospital for Sick Children, Toronto, Canada. Participants Forty-one female children and adolescents who underwent operative management of an ovarian dermoid cyst. Main Outcome Measures Surgical approach (laparoscopy vs laparotomy), intraoperative cyst rupture, length of hospital stay, and postoperative complications. Results The mean age was 12.5 years. All cysts were unilateral. Twenty-three patients (56%) underwent laparoscopic cystectomy, 14 (34%) underwent cystectomy via laparotomy, and 4 (10%) oophorectomies were performed via laparotomy. Cyst size was significantly larger in the laparotomy group compared to the laparoscopy group (mean diameter 14.4 cm vs 7.1 cm, respectively, P < .001). A significantly higher rate of cyst rupture was experienced during laparoscopic cystectomy (100%), compared to excision via laparotomy (27.7%, P < .001). Length of hospital stay was significantly shorter in the laparoscopy group compared to the laparotomy group (median of 0 vs 3 days, respectively, P < .001). A single case in the laparoscopy group sustained a bladder injury and developed postoperative necrotizing fasciitis resulting in a prolonged hospitalization and recovery. There were no operative or postoperative complications related to cyst content spillage, regardless of the surgical approach. Conclusion Laparoscopic cystectomy is a safe and effective method of managing ovarian dermoid cysts in the pediatric and adolescent patient population.