Laparoscopy-assisted transumbilical extracorporeal cyst deroofing for the management of neonatal ovarian cysts
Ahmed A Youssef1, Mahmoud M Marei2, Mohamed H Abouelfadl2, Wesam M Mahmoud2, Atef S.A Elbarawy3
1 Department of Pediatric Surgery, El-Demerdash Hospital, Faculty of Medicine, Ain Shams University; Department of Pediatric Surgery, King Abdulaziz Medical City, Al-Hasa, Kingdom of Saudi Arabia, Egypt
2 Department of Surgery, Pediatric & Neonatal Surgery Unit, Cairo University Specialized Pediatric Hospital (CUSPH), Faculty of Medicine, Cairo University, Egypt
3 Department of Pediatric Surgery, King Abdulaziz Medical City, Al-Hasa; Department of Surgery, Pediatric Surgery Unit, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt, Kingdom of Saudi Arabia
MD Mahmoud M Marei
Pediatric & Neonatal Surgery Unit, Abulreish Hospital (Cairo University Specialized Pediatric Hospital), 1 Aly Pacha Ibrahim Street (from Kasr Alainy Street), El-Moneira District, Cairo 11562
Source of Support: None, Conflict of Interest: None
Background Congenital ovarian cysts affect newborn female infants with an increasing incidence. Many of these cysts are clinically insignificant and resolve spontaneously. Complex cysts of any size and simple cysts larger than 5 cm should be operated upon. Laparoscopy is becoming the mainstay of management. We report our experience with the laparoscopy-assisted transumbilical extracorporeal approach in neonates with ovarian cysts.
Patients and methods In this prospective cohort study, 17 pregnant ladies presented with a routine antenatal ultrasound anomaly scan showing an abdominal cyst in their female fetuses, likely ovarian in origin. A multidisciplinary counseling meeting was conducted with the expectant couple. Postnatal ultrasonography confirmed the diagnosis in 15 patients, whereas two patients showed resolution. Conservative management was pursued in patients with cyst size less than 5 cm. Patients with ovarian cysts larger than 5 cm were operated upon electively.
Results Age at surgery ranged from 4 to 11 days, and patients’ weight ranged from 2.8 to 3.7 kg. Thirteen patients were full term, whereas only two were preterm. The cyst diameter (whether operated upon or not) ranged from 2.7 to 6.2 cm. All patients with cysts smaller than 5 cm resolved spontaneously over a 6-month period. Laparoscopy-assisted transumbilical extracorporeal cyst deroofing was attempted in 11 patients (mean cyst diameter, 5.6 cm). The mean operative time was 36 min. None of the patients showed recurrence or formation of new cysts.
Conclusion Laparoscopy-assisted transumbilical extracorporeal cyst deroofing achieves safety, reproducibility, organ preservation, and minimal invasiveness in neonates with ovarian cysts.