Even in the hand of experienced laparoscopic surgeon the Dermoid cyst or infact any ovarian cyst rupture. Dermoid cyst is the most frequent benign ovarian tumor. Spillage of cyst contents during surgery is common and can rarely lead to chemical peritonitis.

 

This rupture is due to thin dissectors or traumatic graspers used to hold dermoid cyst during laparoscopic surgery. Instipe of this frequent rupture of ovarian cyst during laparoscopic surgery, experienced laparoscopic surgeons should consider laparoscopy instead of laparotomy in control over ovarian dermoid cysts in majority of cases. Throughout the laparoscopic surgery there's a myth that when dermoid cyst will rupture it'll create a big proble. However this old conception is not valid in the era of laparoscopic surgery.

Dermoid cysts were composed of tissue developed from three germinative layers,and in few cases only from two germinative layers a treadmill germinative layer. No intra or postoperative complications occurred. No indicators of chemical peritonitis were observed no matter cystic spillage or otherwise. We conclude the chance of chemical peritonitis can be minimized when undertaking laparoscopic removal of ovarian dermoid cysts when the peritoneal cavity is washed out thoroughly from spillage of cyst contents. Drainage of peritoneal cavity ought to be performed in the patients with the ruptured dermoid cysts.

To reduce spillage from the cyst's contents and subsequent complications, the minimal access surgeon should choose the strategy that is more efficient and less traumatic to the patient. Among the suggested techniques at World Laparoscopy Hospital we use the technique of  combined ovarioscopy and laparoscopy with direct drainage of the cyst content by suction or inside the endobag after which cyst removal, especially for large adnexal masses is carried out.

If spillage occurs, complete elimination of cyst contents and copious lavage ought to be performed to prevent peritonitis. Although peritonitis following rupture of the dermoid cysts which is over explained by some gynecologists but in reality they are are very rare. Even if it occure being conscious of this complication is the key to diagnosis and appropriate management. Whether or not the chemical peritonotiis develop early recognition and prompt treatment by repeat laparoscopic surgery with removal of remaining dermoid cyst contents and peritoneal lavage could be a successful approach to treating chemical peritonitis.