Laparoscopic management of suspicious adnexal masses

ABSTRACT

To evaluate the role of operative laparoscopy in the management of suspicious adnexal masses. Department of Obst. and Gyn., Al-Minya University Hospital. Fifty patients with suspicious adnexal masses were recruited. They were subjected to detailed clinical evaluation, transvaginal sonographic scoring, CA 125 assay and then operative laparoscopic intervention was carried out. In 5 cases, the initial procedure was completed by laparotomy. Preoperative transvaginal sonographic scoring revealed a statistically highly significant difference between benign and malignant lestons, their score were 7.89 +/- 2.7 and 12.5 +/- 2.5 respectively. Serum CA 125 at a cut off 194 u/ml aided by transvaginal sonographic scoring were found helpful in selecting patients with suspicious adnexal masses who may benefit from operative laparoscopy. Laparoscopic intervention was successful in 90% of cases. Procedures done included ovarian cystectomy in 44%, oophrectomy in 16%, excision of cyst wall and aspiration in 12%, adnexectomy in 12% and destruction of cyst wall in situ in 6% of cases. The mean duration of laparoscopic procedure was 67.64 +/- 20.71 min. compared to 102 +/- 7.51 min. following laparotomy. Also the hospital stay was 44.62 +/- 19.96 hrs following laparoscopy versus 76.8 +/- 26.29 hrs following laparotomy. The difference was statistically significant in these two aspects. Laparoscopy is safe and effective in management of adnexal pathologies with minimal hospital stay, when care is taken to avoid rupture and spillage of cyst contents, and thorough inspection of the mass and abdominal cavity is made possible. Thorough preoperative sonographic scoring, tumor markers assay are essential