The role of laparoscopy in the management of adnexal lesions in children.
OBJECTIVE
Laparoscopy has replaced laparotomy in a variety of surgical abdominal conditions. In pediatric patients the vast majority of adnexal lesions are benign. The aim of this study was to assess the safety and feasibility of laparoscopy in adnexal pathology in children.


METHODS
The case notes of girls with confirmed adnexal disorders treated in a single center between 1998 and 2008 were reviewed retrospectively. Demographic data, clinical and imaging features, surgical findings and procedures, pathologic features, complications, and outcomes were recorded.


RESULTS
Over a 10-year-period 21 patients underwent laparoscopic surgery. Median age at operation was 14 years (range: 2 d to 16 y). Laparoscopy was diagnostic in 1 patient whereas it was therapeutic in 14; 2 patients underwent a laparoscopy-assisted minilaparotomy. The procedure was converted to open in 4 patients due to technical difficulties. The most commonly performed procedures laparoscopically were cyst aspiration (n=6), cystectomy (n=4), unilateral oophorectomy (n=2), and cyst aspiration with deroofing (n=2). No operative or postoperative complications occurred. The overall mean postoperative length of stay was 2.3 days (range: 1 to 6 d); it was 1.8 days (range: 1 to 3 d) for patients who had laparoscopic procedures. Pathology revealed benign lesions in all cases.


CONCLUSIONS
In children with benign adnexal pathology, minimally invasive surgery is a feasible and safe approach. Additional benefits of shorter hospital stay, superior cosmetic result, and lesser risk of infertility, make laparoscopy a method of choice for managing pediatric patients.
Panteli
Christina
C
Department of Paediatric Surgery, Norfolk and Norwich University Hospital, Norwich, UK. chpanteli@doctors.org.uk
Minocha
Ashish
A
Kulkarni
Milind S
MS
Tsang
Thomas
T
D000291:Adnexal Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D000293:Adolescent; D002648:Child; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010535:Laparoscopy / Q000009:adverse effects*; D007813:Laparotomy; D007902:Length of Stay; D019060:Minimally Invasive Surgical Procedures; D010048:Ovarian Cysts / Q000000981:diagnostic imaging / Q000601:surgery; D010052:Ovariectomy; D012189:Retrospective Studies; D014463:Ultrasonography