[Laparoscopic treatment of ovarian cysts in women over 40]

Laparoscopy constitutes the main surgical method for treating benign ovarian pathology in women under 40 years of age. The discussion is about the possibility of extending this surgical method to patients over 40 in whom the risk of malignant ovarian pathology is either borderline or considerably higher. The objective of this study was to evaluate the feasibility of laparoscopic treatment for these patients, who have been submitted to adequate screening, comparing the results of echographic diagnosis, laparoscopy and histology.

This study includes 65 patients, all over 40 (average age 51 years, range 41-71 years): 34 were in menopause and 31 had a normal menstrual cycle. All were suffering from ovarian pathology. They were selected on the basis of a diagnostic protocol and then submitted to laparoscopic treatment and a follow-up check.

The laparoscopic approach led to a clear improvement of the diagnosis compared to echography and dosage of the markers. The percentage of similarity between echographic and laparoscopic diagnosis was 84.6% while in the case of echographic diagnosis and histological examination this was 78%. The percentage of similarity between laparoscopic and histological diagnosis was 94%. Only one case of conversion to laparotomy occurred.

Patients over 40 years of age can present a wide range of pathologies that can be treated by means of laparoscopy. Never the-less, also when confronted with an unclear diagnosis, which would otherwise require laparotomy, the laparoscopic approach significantly improves of the diagnosis without any ultimate worsening of the prognosis.