Laparoscopy versus Laparotomy for Pediatric Ovarian Dermoids

Background: Pediatric ovarian dermoids have been historically resected by laparotomy out of concern for intraoperative tumor spillage, resultant peritonitis, adhesion formation resulting in pain or infertility, incomplete resection, and increased recurrence rates compared to laparoscopy. Recently, more cases are being performed laparoscopically with limited data on outcomes and safety. With increased surgeon comfort using laparoscopy, we hypothesized that the resection of pediatric ovarian dermoids using laparoscopy will yield a shorter length of stay and no increase in morbidity or recurrence compared to laparotomy.

Methods: A retrospective review was performed amongst eleven tertiary pediatric hospitals in the United States. Children aged 2 to 21 years who underwent resection of an ovarian dermoid at one of the participating institutions from January 2010 to December 2020 were included. Operative details, length of stay, follow-up visits and imaging, and subsequent operative intervention details were collected. We evaluated the distribution of patient characteristics and operative details and outcomes by surgical approach using Chi-squared tests for categorical variables and Wilcoxon-Mann tests for continuous variables. Statistical significance was evaluated at an alpha level of 0.05.

Results: 466 patients were included, with a median age of 14.4 years and a median follow-up time of 199 days (IQR: 512 days) (Table 1). 279 patients underwent laparoscopy (60%), 139 patients underwent laparotomy (30%), and 48 patients underwent a laparoscopic converted to open procedure (10%). 65% of patients underwent ovarian-sparing surgery and 35% underwent oophorectomy. Pediatric surgeons performed over half the operations. Rates of using laparoscopic or open approaches were similar by specialty but pediatric surgeons more frequently converted from a laparoscopic to open procedure (p=0.002). Patients who had larger lesions were more likely to undergo laparotomy (11.4 cm for laparotomy versus 7.2 cm for converted procedures and 6.4 cm for laparoscopic procedures, p<0.001). There were no differences in the rates of tumor spillage by surgical approach (p=0.15). Length of stay was significantly shorter amongst patients who underwent laparoscopy (1 day for laparoscopy versus 2 days for converted procedures versus 2 days for laparotomy, p<0.0001). Across the three different operative techniques, there were no differences amongst the rates of reoperation or recurrence rates (p=0.82 and p=0.43, respectively).

Conclusion: Patients who underwent laparoscopy for a pediatric ovarian dermoid experienced no differences in the rates of intraoperative tumor spillage, reoperation, or recurrence compared to patients who underwent laparotomy. Patients with larger lesions on preoperative imaging were more likely to undergo open resection than those with smaller lesions. Those who underwent laparoscopy had a shorter length of stay compared to patients who underwent laparotomy or a converted procedure. Laparoscopy is an acceptable surgical approach for resection of ovarian dermoids in pediatric patients.

Presenting Author(s)

Maria E. Knaus, MD
Pediatric Surgery Research Fellow
Nationwide Children's Hospital
Columbus, Ohio
Disclosure: No Financial Relationships Disclosed

Co-Author(s)

AO
Amanda Onwuka, PhD, MPH
Research Scientist
Nationwide Children's Hospital, Center for Surgical Outcomes Research
Columbus, Ohio
Disclosure: No Financial Relationships Disclosed
PD
Patrick Dillon, MD
Associate Professor of Surgery
St. Louis Children's Hospital
St. Louis, Missouri
Disclosure: No Financial Relationships Disclosed
PE
Peter Ehrlich, MD, MSc
Professor of Surgery
CS Mott's Children's Hospital
Ann Arbor, Michigan
Disclosure: No Financial Relationships Disclosed
MF
Mary E. Fallat, MD
Pediatric Surgeon
Norton Children’s Hospital and Hiram C. Polk, Jr Department of Surgery, University of Louisville
Louisville, Kentucky
Disclosure: No Financial Relationships Disclosed
Jason D. Fraser, MD
Pediatric Surgeon
Division of Pediatric Surgery, Department of Surgery, Children’s Mercy Hospital
Univerisity of Missouri-Kansas City, Children's Mercy Kansas City
Kansas City, Missouri
Disclosure: No Financial Relationships Disclosed
JG
Julia Grabowski, MD
Assistant Professor of Surgery
Lurie Children's Hospital
Chicago, Illinois
Disclosure: No Financial Relationships Disclosed
Paige Hertweck, MD
Professor of Obstetrics/Gynecology
Norton Children's Hospital
Louisville, Kentucky
Disclosure: AbbVie (Products/Services: perform research for AbbVie regarding endometriosis/dysmenorrhea/pelvic pain) (Contracted Research (Principal Investigators must provide information, even if received by the institution))
RK
Rashmi D. Kabre, MD
Pediatric Surgeon
Division of Pediatric Surgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine
Chicago, Illinois
Disclosure: No Financial Relationships Disclosed
Dave R. Lal, MD, MPH
Pediatric Surgeon
Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin
Medical College of Wisconsin/Children's Wisconsin
MILWAUKEE, Wisconsin
Disclosure: No Financial Relationships Disclosed
ML
Matthew P. Landman, MD, MPH
Pediatric Surgeon
Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine,
Indianapolis, Indiana
Disclosure: No Financial Relationships Disclosed
CL
Charles M. Leys, MD, MSC
Pediatric Surgeon
Division of Pediatric Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health
Madison, Wisconsin
Disclosure: No Financial Relationships Disclosed
GM
Grace Mak, MD
Pediatric Surgeon
Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine
Chicago, Illinois
Disclosure: No Financial Relationships Disclosed
EO
Elliott Overman, Jr., MD
Fellow
C.S. Mott Children's Hospital
Ann Arbor, Michigan
Disclosure: No Financial Relationships Disclosed
MR
Manish Raiji, MD
Assistant Professor of Surgery
Comer Children's Hospital, The University of Chicago Medicine
Chicago, Illinois
Disclosure: No Financial Relationships Disclosed
BR
Beth A. Rymeski, DO
Assistant Professor
Cincinnati Children's Hospital
Cincinnati, Ohio
Disclosure: No Financial Relationships Disclosed
Jennifer H. Aldrink, MD
Professor of Clinical Surgery and Pediatrics
Nationwide Children's Hospital
Nationwide Children's Hospital, The Ohio State University College of Medicine
Columbus, Ohio
Disclosure: No Financial Relationships Disclosed
GH
Geri Hewitt, MD
Professor of Obstetrics/Gynecology and Pediatrics
Nationwide Children's Hospital
Columbus, Ohio
Disclosure: No Financial Relationships Disclosed

Senior Author(s)

PM
Peter C. Minneci, MD, MHSc
Pediatric Surgeon
Center for Surgical Outcomes Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, The Ohio State University College of Medicine and 5Department of Pediatric Surgery, Nationwide Children’s Hospital
Columbus, Ohio
Disclosure: No Financial Relationships Disclosed
KD
Katherine J. Deans, MD, MHSc
Pediatric Surgeon
Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery,Nationwide Children's Hospital
Columbus, Ohio
Disclosure: No Financial Relationships Disclosed