Surgical management of ovarian disease in infants, children, and adolescents: a 15-year review.
BACKGROUND
Despite the reported efficacy and the presumed benefits of minimally invasive surgery (MIS) for ovarian lesions in adults, questions remain as to the surgical indications, results, and outcomes for these procedures across pediatric age groups. The aim of this study was to review our experience with the management of ovarian disease in children to determine if there has been a shift in the management of these lesions from open surgery (OS) to an MIS approach in the pediatric population.


METHODS
An institutional review board (IRB)-approved retrospective chart review included all patients who underwent surgical management of ovarian disease from January 1, 1992 to July 10, 2007. Patients with ectopic pregnancy, known pelvic inflammatory disease, or concomitant illness requiring operative management at the time of ovarian surgery were excluded. Demographics, clinical signs and symptoms, diagnosis, surgical outcomes, and history of prior abdominal procedures were obtained. Statistical analysis included comparison of means, paired t-test, chi-squared test, and multivariate analysis, where indicated.


RESULTS
A total of 231 patients were evaluated in this study, with a mean age of 12.8 years (range, 3 weeks to 20 years). There were 221 (95.7%) benign lesions and 10 (4.3%) were malignant. There were 156 simple or hemorrhagic cysts (70.5%) and 46 mature teratomas (20.8%). Three complications (1.3%) occurred, which were associated with surgery and no mortalities. Abdominal pain (82.3%), nausea or vomiting (24.2%), and abdominal tenderness (10.0%) were the most common presenting symptoms or signs. Operative outcomes for benign disease (n = 221) were compared between MIS and open cases over the entire time period as well as within three consecutive 5-year time intervals.


CONCLUSIONS
There was a notable shift toward the management of benign ovarian disease in using MIS techniques over the course of three different 5-year intervals. This approach was also associated with shorter hospital stay, less operative blood loss, and shorter operative times, when compared to an open approach. When indicated, a laparoscopic approach should be performed for presumed benign ovarian disease in children.
Michelotti
Brett
B
Division of Pediatric General and Thoracic Surgery, Children's Hospital of Pittsburgh of UPMC and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Segura
Bradley J
BJ
Sau
Indranil
I
Perez-Bertolez
Sonia
S
Prince
Jose M
JM
Kane
Timothy D
TD
D000293:Adolescent; D016063:Blood Loss, Surgical; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007902:Length of Stay; D019060:Minimally Invasive Surgical Procedures; D010048:Ovarian Cysts / Q000601:surgery; D010049:Ovarian Diseases / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000601:surgery; D011183:Postoperative Complications; D012189:Retrospective Studies; D013724:Teratoma / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult