Symptomatic Ovarian Cyst In Pregnancy -Laparoscopic Assisted Ovarian Cystectomy —An Alternative, Qualitative, Feasible, Safe Option.

Abstract

Study objects: To assess the feasibility and safety of laparoscopic approach for symptomatic ovarian cyst in pregnancy. Design: This is a retrospective analysis of symptomatic ovarian cysts in pregnancy of four pregnant women managed by Laparoscopic Assisted Cystectomy. Setting: Melaka General Hospital, Melaka, Malaysia A Teaching tertiary hospital for under and postgraduate students . Patients: Four ante-natal patients with symptomatic ovarian cysts of different sizes ranging from 12 weeks to 26 weeks in 1st and 2nd trimester of pregnancy from August 2005 to May 2007. Intervention: Laparoscopic Assisted Cystectomy in pregnancy.Measurements and Main results: Out of 4 four cases, two in first trimester of pregnancy about 9-11/52 (nine to eleven weeks) size presented with acute abdomen. Others were in about 14 to 18 weeks with recurrent pressure symptoms contributing to continuous lower abdominal pain and urinary obstruction. The size of cysts varied from 12weeks to 26 weeks of pregnancy with clinical diagnosis of serious cyst adenoma in 2 cases and dermoid cyst in another two cases. All patients were duly counseled about the probable anesthesia risk and also the benefits and risks of the open versus laparoscopic approach. Under general anesthesia all case were successfully operated maintaining 10 mm Hg intra abdominal pressure without any Trendlenburg position. Mean blood loss was less than 50 cc with average operating time less than 50 minutes. Mean hospital stay was about 36 hours. There was no miscarriage or preterm labour. All except one(caesarean section) had spontaneous uneventful vaginal delivery with normal apgar score without any gross abnormality. On follow-up, both mothers and babies are well. Histopathology reported benign serous cystadenoma in two cases and mature dermoid cysts in other cases. No evidence of malignancy seen. On follow up all babies had normal growth chart. Conclusion: Laparoscopic Assisted Ovarian Cystectomy in pregnancy in selected cases is a feasible, safe,qualitative and an alternative option.