LAPAROSCOPIC TREATMENT OF DERMOID CYSTS

There is some controversy about the use of laparoscopic procedures for dermoid cysts since they involve the risk of abacterial peritonitis a nd of malignant growths produced by surgery. From 1992 to June 1996 we performed 208 operations for teratoma. Laparoscopy was sufficient in 184 cases (88%), while laparotomy had to be performed in 24 cases. In 14 cases (8%) the laparoscopic procedure consisted of adnexectomy or o variectomy; in all other cases it was possible to preserve the organ. The mean age of the patients treated by laparoscopy was 34 years. In t he laparotomy group the mean age was 41 years. The average sonographic diameter of the dermoid cysts removed by laparoscopy amounted to 5 cm (range 1.3-10 cm), the cysts removed by laparotomy measured 8 cm in d iameter on an average (range 4-17 cm). Slight complications developed in 5% of the cases following laparoscopy, such as laceration of epigas tric vessels, a drop in Hb of less than 8 g%, which did not require a transfusion, temperature above 38 degrees C as well as subileus. In th at particular patient two endometriosal cysts had been removed at the same time. None of the cases required a repeat procedure. Two malignan t teratomas were found in these 208 cases, namely, a 17 cm solid terat ome in a 77-year-old patient and a tumour of the size of a child's hea d in the lower abdomen in a 26-year-old. Both patients were initially treated by laparotomy. Only rarely is it possible to remove the entire dermoid cyst via a Lap Sac without contaminating the abdominal cavity with the contents of the cyst. Careful washing of: the abdomen using saline solution at body temperature is obligatory to prevent abacteria l peritonitis. Adnexectomy via Lap Sac or by means af laparotomy is th erefore the procedure of choice in postmenopausal women. In young pati ents we consider laparoscopy to be the method of choice too. If, howev er, a malignant teratoma is suspected, tumour of rapid growth, large s olid tumour, or adhesions, laparotomy is indicated in most cases.