Page 53 - WJOLS - Journal of Laparoscopic Surgery

Priyanka Shekarappa
Prevention of Spillage of Cyst Contents during Table 1: Comparison of number of dermoid cysts ruptured and
Cystectomy and Management of Consequences incidence of chemical peritonitis in various studies
if Rupture occurs Dermoid cysts Number Incidence
removed by of cysts of chemical
During laparoscopic cystectomy, about 40 to 50% of cysts Journal laparoscopy ruptured peritonitis
rupture. Laparoscopic 93 39 0.2%
To prevent the cyst contents entering into the perito- management of dermoid
cysts, JSLS—10 years
neal cavity, before starting cystectomy, an endobag is kept Does prevention of 314 26 0.2%
open underneath the cyst so that if it ruptures contents intraperitoneal spillage
will spill into the endobag and not into the peritoneal when removing a
cavity. dermoid cyst prevent
granulomatous peritonitis,
The endobag should be of good quality so that it does BJOJ—20 years
not tear while retrieving the cyst as the cyst might contain Factors that increase 178 115 Nil
sharper contents like tooth. the risk of leakage
If there is spillage of cyst contents in spite of all pre- during surgical removal
of benign cystic
cautions, the abdominal cavity should be irrigated with teratomas—5 years
warmed fluid (NS/RL) with skimming of floating debris
with suction tube until clear. Cold fluid may solidify the
fat-rich contents and make retrieval of spilled contents tonitis is very less compared with spillage rates when
more difficult and can cause hypothermia. 8-10 appropriately managed following spillage.

Consequences of Cyst Rupture REFERENCES

• Adhesions 1. RCOG guidelines no. 62 published in November 2011.
• Fistulization 2. Quinn SF, Erickson S, Black WC. Cystic ovarian teratomas:
• Chemical peritonitis the sonographic appearance of the dermoid plug. Radiology
1985 May;155(2):477-478.
• Squamous cell carcinoma 3. Benezra V, Verma U, Wayne Whitted R. Comparison of
laparoscopy versus laparotomy for the surgical treatment of
Note on Laparoscopic Cystectomy ovarian dermoid cysts. Gynaecol Surg 2005 Jul;2(2):89-92.
during Pregnancy 4. Campo S, Garcea N. Laparoscopic conservative excision of
ovarian dermoid cysts with and without an endobag. J Am
• Protect the uterus while placing trocars Assoc Gynaecol Laparosc 1998 May;5(2):165-170.
• Low pressure pneumoperitoneum 5. Shalev E, Bustan M, Romano S, Goldberg Y, Ben-Shlomo I.
• Maternal end tidal CO gas level should be maintained Laparoscopic resection of ovarian benign cystic teratomas:
2
• Mobilization of the patient soon after the surgery experience with 84 cases. Hum Reprod 1998 Jul;13(7):
1810-1812.
Laparoscopic cystectomy is superior to laparotomy. 6. Morgante G, Ditto A, La Marca A, Trotta V, De Leo V. Surgi-
Although there is high rate of rupture, the incidence cal treatment of ovarian dermoid cysts. Eur J Obstet Gynecol
of chemical peritonitis is only 0.2% (Table 1). In 2009, a Reprod Biol 1998 Oct;81(1):47-50.
Cochrane review which included 12 randomized control 7. O’Neill KE, Cooper AR. The approach to ovarian dermoids in
trials concluded laparoscopy was superior to laparotomy. adolescents and young women. J Paediatr Adolesc Gynaecol
Although there was inadvertent rupture of cysts during 2011 Jun;24(3):176-180.
laparoscopy, no statistical difference was found between 8. Milad MP, Olson E. Factors that increase the risk of leakage
the two treatment arms regarding total number of during surgical removal of benign cystic teratomas. Hum
Reprod 1999 Sep;14(9):2264-2267.
adverse events of surgery. 9. Kondo W, Bourdel N, Cotte B, Tran X, Botchorishvili R, Jardon K,
Rabischong B, Pouly JL, Mage G, Canis M. Does prevention of
CONCLUSION intraperitonial spillage when removing a dermoid cyst prevent
granulomatous peritonitis. BJOG 2010 Jul;117(8):1027-1030.
Laparoscopic cystectomy of dermoid cysts is considered 10. Malhotra A, Grimes C, Nikolić M. Severe granulomatous
to be a safe procedure in the hands of experienced sur- peritonitis and small bowel fistula formation following the
geons when compared with the morbidity and mortality excision of an ovarian dermoid cyst: a case report. Gynaecol
associated with laparotomy. Incidence of chemical peri- Surg 2008 May;5(2):157-159.

134