Ovarian Dermoid Cysts: Does Size Matter When it Comes to Laparoscopic Surgery?

Objectives This study aims to determine the sensitivity of preoperative imaging in detecting ovarian dermoid cysts. It aims to explore cyst size as a determinant of surgical approach, intraoperative surgical complications such as cyst spillage/leak, and the postoperative complication of chemical peritonitis. It delves into the discussion of torsion, determining the sensitivity of vomiting as a presenting symptom and the accuracy of preoperative Doppler ultrasound in detecting torsion by correlating radiological diagnosis with the intraoperative diagnosis. Methods Eighty-seven cases were retrospectively extracted from the Department of Obstetrics and Gynecology at Latifa Women and Children Hospital, Dubai, United Arab Emirates, between November 2017 and February 2020. Results  Of the 87 cases, 71 underwent transvaginal or transabdominal ultrasonography, 17 underwent CT scan, and 10 underwent MRI. Nine cases underwent both ultrasound and CT scan. Eight cases underwent ovarian cystectomy or oophorectomy via laparotomy, whereas 79 cases underwent ovarian cystectomy or oophorectomy via laparoscopy. Torsion was suspected in patients presenting with vomiting. Preoperative Doppler ultrasound was used to detect the presence of torsion, which was confirmed intraoperatively. Conclusions  Ultrasound is 70% sensitive, with an 81% positive predictive value, in detecting dermoid cysts. Cyst size affects the choice of surgical approach (p<0.02), with larger cysts undergoing laparotomy, although laparotomy has a higher risk of an intraoperative leak. Cyst size did not influence the risk of leak (p<0.59), and no cases of chemical peritonitis were recorded following effective intraoperative peritoneal washouts. Vomiting as a presenting complaint indicates the presence of torsion (p<0.001), with a sensitivity of 70% and specificity of 80.6%. Almost 90% of torsion cases were identified preoperatively via ultrasound Doppler and confirmed intraoperatively.