LAPAROSCOPY IN ADNEXAL PATHOLOGY IN THE CHILD - A STUDY OF 28 CASES

We report our experience with laparoscopy in adnexal pathology in the child. Twenty-eight children (mean age 13 years; range 8 to 16) underw ent 30 laparoscopy procedures. Therapeutic laparoscopy was performed i n 3 cases: transposition of an ovary before radiotherapy, bilateral go nadal excision for Turner's syndrome and ovarian fixation after contra lateral torsion of normal adnexa (TNA). Diagnostic and potentially the rapeutic laparoscopy was performed in 25 cases: 12 suspected torsion o f adnexa (6 confirmed), 4 possible ovarian or appendicular pathology ( 1 appendicitis), 4 to confirm the histological nature of an ovarian tu mor (2 functional cysts, 1 old TNA, 1 dermoid cyst), 3 suspected salpi ngitis (2 confirmed), and 2 chronic pelvic pain (1 endometriosis). No pathology was found in 2 cases, and in 1 case pelvic adhesions prevent ed confirmation of the diagnosis. Thirteen laparoscopically-guided sur gical acts were performed: 2 detorsions of adnexa, 2 excisions of necr osed adnexa and 9 punctures with or without biopsy for functional cyst s. Intralaparoscopic detorsion of TNA was complicated in one case by f ibrinolysis requiring secondary laparotomy. Mean hospitalisation was 3 days (range 1 to 16). The preferential therapeutic indications for la paroscopy in the child are transposition of an ovary and ablation of t he gonads in case of sexual ambiguity. It is used diagnostically in ca ses of sudden pelvic pain. In addition to this diagnostic role, it now allows most treatments to be carried out (detorsion with or without f ixation, transparietal cystectomy), including those for associated les ions (appendicectomy). Its morbidity is quite low, which warrants incr easing the number of indications in pediatric pathology.