Elsevier

Journal of Pediatric Surgery

Volume 42, Issue 12, December 2007, Pages 2136-2139
Journal of Pediatric Surgery

Operative technique
Transumbilical management for neonatal ovarian cysts

https://doi.org/10.1016/j.jpedsurg.2007.08.009Get rights and content

Abstract

Background/Purpose

Since Tan and Bianchi (Br J Surg. 1986;73:399) reported umbilical incision as an access for pyloromyotomy in infantile hypertrophic pyloric stenosis, many pediatric surgeons have used this approach for a number of other procedures. Because of the long pedicle with good mobility and the frequent intraabdominal position of the neonatal ovarian cyst, we attempted to manage it via the transumbilical route.

Methods

All patients were treated under intubation general anesthesia. Semicircular infraumbilical incision was made, and the abdomen was entered through a transverse fascial incision. The partially collapsed cyst after aspiration was exteriorized through the incision for cystectomy, partial deroofing, or adnexectomy.

Results

From May 2000 to December 2006, 6 female newborns with ovarian cysts were treated via the transumbilical route. There were no complications from surgery. The operation time and duration of hospital stay were short. The cosmetic appearance after the procedure was good.

Conclusions

The initial result suggests that transumbilical management for neonatal ovarian cysts may be a good alternative procedure when laparoscopic equipment is unavailable or experienced technique is lacking.

Section snippets

Materials and methods

From May 2000 to December 2006, 6 female newborns with ovarian cysts were treated via the transumbilical route. All patients were detected by prenatal ultrasound scan and referred to our institution after birth. Postnatal ultrasound was performed in all cases, and one case with initial diagnosis of teratoma received an additional computed tomographic scan. Indications for surgery are large symptomatic simple cyst and complex cyst diagnosed by ultrasound and, if necessary, computed tomographic

Results

All infants were full term (Table 1). The cysts were simple in 3 cases, whereas the other 3 cases were complex. Average size was 8.1 cm (range, 6.7-9.5 cm) for the simple cysts and 5.6 cm (range, 4.5-6.7 cm) for the complex cysts. Cases 1 and 3 developed respiratory distress owing to the mass effect of large cystic size after birth, and case 1 even needed emergent intubation. The average age at operation was 8.5 days (range, 2-20 days). The mean operating time was 27.6 minutes (range, 21-43

Discussion

After the introduction of ultrasound for the routine monitoring of pregnancy, the incidence of ovarian cysts progressively increased. Thus, the natural course of ovarian cysts has become clearer. Cysts smaller than 4 to 5cm in diameter tend to regress or resolve spontaneously in 3 to 4 months [2], [3]; and the incidence of torsion is low, although it has occurred in cysts as small as 2 cm [4]. According to the previous reports [2], [5], [6], cysts with a diameter larger than 5 cm and a volume

Conclusions

Our initial results suggest that transumbilical management for neonatal ovarian cysts is feasible. The technique is easy, and surgical exposure is adequate. It offers a good cosmetic appearance like other minimally invasive procedures. Although no complication has been found until now, more cases are needed for further investigation.

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