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Laparoscopy Versus Laparotomy for Surgical Management of Ovarian Dermoid Cysts in Children: A Systematic Review and
Nicole Smith1, Justin Wei-Jia Lim2, Carolyn Ziegler3
1Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Insights
Laparoscopic ovarian dermoid cyst surgery in pediatric patients shows a higher risk of intraoperative rupture compared to laparotomy. However, recurrence rates and peritonitis were similar between both surgical approaches.
Area of Science:
- Gynecologic Surgery
- Pediatric Surgery
- Oncology
Background:
- Ovarian dermoid cysts are common germ cell tumors in pediatric and adolescent females.
- Surgical management aims to remove the cyst while preserving ovarian function.
- Laparoscopy and laparotomy are the primary surgical approaches, each with potential benefits and risks.
Purpose of the Study:
- To compare intraoperative cyst rupture, peritonitis, and cyst recurrence rates between laparoscopic and laparotomy approaches for ovarian dermoid cyst surgery in pediatric and adolescent patients.
Main Methods:
- A systematic review and meta-analysis adhering to PRISMA guidelines and Cochrane Handbook.
- Searched five bibliographic databases and three clinical trial registries from inception to August 29, 2024.
- Included quasi-/randomized trials and prospective/retrospective cohort studies comparing laparoscopy versus laparotomy for ovarian dermoid surgery.
Main Results:
- Included 6 studies with 893 patients (laparoscopy: 53.9%, laparotomy: 39.5%, converted: 6.6%).
- Meta-analysis revealed a significantly higher risk of intraoperative cyst rupture with laparoscopy (RR 2.47, 95%CI 1.40-4.37).
- No significant difference in cyst recurrence (RR 0.92, 95%CI 0.41-2.08) or observed cases of chemical peritonitis.
Conclusions:
- Laparoscopy for pediatric ovarian dermoid cysts may increase the risk of intraoperative rupture compared to laparotomy.
- Post-operative peritonitis was not clinically observed, and recurrence rates were similar between the two surgical methods.
Study Objective:
To compare intraoperative cyst rupture, peritonitis, and cyst recurrence after ovarian dermoid surgery via laparoscopy versus laparotomy in pediatric and adolescent patients.
Methods:
A comprehensive systematic review and meta-analysis was conducted following PRISMA guidelines and the Cochrane Handbook for Systematic Reviews. Five bibliographic databases (MEDLINE, Embase, Cochrane CENTRAL, Cochrane Database of Systematic Reviews, Web of Science) and 3 clinical trial registries were searched from inception to August 29, 2024. Eligible studies included quasi-randomized trials and prospective/retrospective cohort studies evaluating intraoperative cyst rupture, peritonitis, or cyst recurrence after laparoscopy versus laparotomy for ovarian dermoid surgery. Two authors independently performed title-abstract and full text screening and independently extracted data. Meta-analyses of cyst rupture and cyst recurrence after laparoscopy versus laparotomy for ovarian dermoid surgery were performed and presented in forest plots. Risk ratios for cyst rupture were pooled with a random-effects model, and for cyst recurrence were pooled with a fixed-effect model. Quality assessment was assessed using the Newcastle-Ottawa Scale.
Results:
A total of 1021 studies were identified, with 6 studies included (2000-2022; Canada, United States, Poland). We included 481 (53.9%) patients who underwent laparoscopy, 353 (39.5%) who underwent laparotomy, and 59 (6.6%) who underwent laparoscopy converted to laparotomy. For meta-analysis, 5 studies were included for cyst rupture, and 4 studies were included for cyst recurrence. Random-effects meta-analysis demonstrated a significantly higher risk of cyst rupture with laparoscopy (RR = 2.47; 95% CI, 1.40-4.37). Fixed-effect meta-analysis found no significant difference in cyst recurrence between laparoscopy and laparotomy (RR = 0.92; 95% CI, 0.41-2.08). No cases of chemical peritonitis were observed.
Conclusion:
For the surgical management of ovarian dermoid cysts in children, laparoscopy may carry a higher risk of intraoperative cyst rupture compared to laparotomy, however our work highlights that subsequent post-operative peritonitis was not clinically observed and recurrence rates remained similar.
