Clinical characteristics and surgical management options for ovarian fibroma/fibrothecoma: a study of 97 cases.

AIMS: The aims of this study were to analyze the clinical characteristics, diagnostic features, and operative outcomes of patients with ovarian fibroma/fibrothecoma and to discuss appropriate management options. METHODS: We performed a retrospective comparative analysis of 97 patients with ovarian fibroma/fibrothecoma who underwent laparoscopic and laparotomic procedures, including tumorectomy between January 2008 and December 2011. RESULTS: The mean patient age was 42.5 ± 11.4 years. Seventy-three patients (75.3%) were premenopausal women. A preoperative diagnosis of benign ovarian tumor or fibroma was made in only 49 cases (50.5%). We found that 42.2% of cases were misdiagnosed as uterine myomas (n = 41) and 6.2% were misdiagnosed as malignant ovarian tumors (n = 6). The presence of ascites was associated with larger tumor size (p < 0.05) but not higher CA125 levels (p = 0.159). Twenty-nine patients (29.9%) underwent laparotomy, and 68 (70.1%), laparoscopic surgery. Laparoscopic surgery facilitated shorter operation times than laparotomy (p < 0.05). Tumorectomy was performed in 40 patients (43.5%), 36 (90%) of whom underwent laparoscopy with operative outcomes comparable to those of patients who underwent laparotomy. CONCLUSIONS: Ovarian fibromas/fibrothecomas are often misdiagnosed as uterine myomas and malignant ovarian tumors. Laparoscopic surgery including tumorectomy may be an effective surgical approach in patients with ovarian fibromas/fibrothecomas.

Laparoendoscopic single-site surgery (LESS) versus conventional laparoscopic surgery for adnexal preservation: a randomized controlled study.

OBJECTIVE: To compare the operative outcomes, postoperative pain, and subsequent convalescence after laparoendoscopic single-site surgery (LESS) or conventional laparoscopic surgery for adnexal preservation. STUDY DESIGN: From December 2009 to September 2010, 63 patients underwent LESS (n = 33) or a conventional laparoscopic surgery (n = 30) for cyst enucleation. The overall operative outcomes including postoperative pain measurement using the visual analog scale (VAS) were evaluated (time points 6, 24, and 24 hours). The convalescence data included data obtained from questionnaires on the need for analgesics and on patient-reported time to recovery end points. RESULTS: The preoperative characteristics did not significantly differ between the two groups. The postoperative hemoglobin drop was higher in the LESS group than in the conventional laparoscopic surgery group (P = 0.048). Postoperative pain at each VAS time point, oral analgesic requirement, intramuscular analgesic requirement, and the number of days until return to work were similar in both groups. CONCLUSION: In adnexa-preserving surgery performed in reproductive-age women, the operative outcomes, including satisfaction of the patients and convalescence after surgery, are comparable for LESS and conventional laparoscopy. LESS may be a feasible and a promising alternative method for scarless abdominal surgery in the treatment of young women with adnexal cysts.

Ovarian leiomyoma as a potential cause of compromised fertility.

OBJECTIVE: To analyze cases of ovarian leiomyomas and to discuss the proper surgical management. DESIGN: A case series and discussion. SETTING: General university hospital and healthcare center. PATIENT(S): Nine patients who were diagnosed with ovarian leiomyomas after surgery between 1993 and 2009. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): A preoperative diagnosis that was matched to the postoperative diagnosis and the type of surgery. RESULT(S): In all cases, ovarian leiomyoma was misdiagnosed preoperatively as pedunculated uterine myoma, ovarian fibroma, or even ovarian endometrioma. Seven (77.8%) of the nine patients underwent a salpingo-oophorectomy or an oophorectomy with or without hysterectomy, and only two (22.2%) patients were submitted to an ovary-preserving surgery (i.e., a cystectomy or ovarian wedge resection). CONCLUSION(S): Because of their extreme rarity, ovarian leiomyomas are seldom suspected intraoperatively or preoperatively. However, most of these tumors appear at reproductive age and have a benign nature, similar to uterine myomas. Therefore, surgeons should perform ovary-preserving management, especially in young patients.