Rupture of Dermoid Cyst During Laparoscopic Cystectomy
Even experienced laparoscopic surgeons accidently rupture dermoid cyst during laparoscopic cystectomy, should consider laparoscopy as an alternative to laparotomy in management of ovarian dermoid cysts in selected cases. The question is, Is it safe to rupture dermoid cyst during laparoscopic surgery? Many sudy is done to analyze the safety of laparoscopy in ovarian dermoid cysts treatment and risk of chemical peritonitis. Spillage rates of dermoid cysts when removed by laparoscopy is reported as 15% to 100% in several series, compared to only 4% to 13% via laparotomy.
In patients with dermoid cyst rupture peritoneal cavity should be washed out thoroughly with Ringer lactate and drained for 24-48 hours. In our experience the risk of chemical peritonitis can be minimized when undertaking laparoscopic removal of ovarian dermoid cysts if the surgeon will use copious lavage and peritoneal cavity is washed out thoroughly from spillage of cyst contents. After removal of the cyst keeping inside an Endobag drainage of peritoneal cavity should be performed in the patients with the ruptured dermoid cysts.
A dermoid cyst of ovary is a saclike growth that is present at birth. It contains many ectodermal structures such as hair, fluid, teeth, or skin glands that can be found on or in the skin. Dermoid cysts of ovary grow slowly and are not tender unless ruptured. They usually occur on the other area of body also such as face, inside the skull, on the lower back, and in the ovaries. Superficial dermoid cysts usually can be removed without complications. Removal of multiloculated inner, rarer dermoid cysts requires special techniques and training.
Ovarian dermoid cysts can develop extensively in a woman during her reproductive years. The ovarian dermoid cyst can cause torsion, infection, rupture, and sometime cancer. These dermoid cysts can be removed with either conventional surgery or laparoscopy or da Vinci robotic surgery that uses small incisions and specially designed instruments to enter the abdomen.
The traditional open surgical approach by laparotomy for a dermoid cyst is cystectomy is still popular, although laparoscopic cystectomy is now widely accepted by gynecologists all over World as another approach. Among the laparoscopic surgeon there is unnecessary fear about the rupture of Dermoid Cyst. Spillage of cyst contents during surgery is common and can rarely lead to chemical peritonitis. Even if chemical peritonitis occur early recognition and prompt treatment by repeat laparoscopic surgery with removal of the remaining cyst contents and peritoneal lavage can be a successful method for treating chemical peritonitis. If the surgeon will do copious lavage during the surgery itself the risk of peritonitis can be minimized.
Few female has been reported presented with chronic granulomatous peritonitis occurring many months postoperatively. The study has shown that chemical peritonitis following dermoid spillage during laparoscopic surgery is a rare complication with an incidence of <1% if cyst contents are carefully and entirely removed. However, with incomplete removal and inadequate removal with inadequate lavage, the incidence of chemical peritonitis is likely much higher as in some of the unfortunate women the body reacts to cyst contents. If a laparoscopic approach is chosen with the attendant higher risk of rupture of the dermoid cyst, the importance of laparoscopic surgical experience and skills of the operating surgeon is clear to minimize the risk of this complication. Because in some of the unfortunate women if it occurs, chemical peritonitis following dermoid spillage can be a very serious complication, sometimes requiring a laparotomy to treat bowel obstruction that results from adhesion.
So in conclusion thorough lavage and complete removal of cyst is required in case of dermoid cyst and in case of peritonotis early recognition and prompt treatment by repeat laparoscopic surgery with removal of remaining residual dermoid cyst contents and thorough peritoneal lavage can be a successful method of treating chemical peritonitis.
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