Revista Chilena de Obstetricia y Ginecología (Jan 2008)
MANEJO QUIRÚRGICO DEL TERATOMA MADURO: ¿LAPAROSCOPIA O LAPAROTOMÍA?
Abstract
Objetivos: Definir los criterios de selección para la vía de abordaje por laparotomía versus laparoscopia. Método: Estudio retrospectivo de los casos de teratoma maduro manejados entre los años 1991 y 2003. Resultados: Los teratomas maduros corresponden al 14% de los tumores ováricos. La edad de presentación correspondió mayoritariamente a mujeres en edad reproductiva (67%). Trece casos se presentaron en embarazadas, 11 durante la cesárea. La presentación más frecuente fue como hallazgo clínico o a la ultra-sonografía pelviana durante el estudio por otra patología. En la mitad de los casos el abordaje fue por vía la-paroscópica (LPX). En tumores mayores de 9 cm, se privilegió la laparotomía (LPE) (pObjectives: To define selection criteria for surgical approach, laparoscopy or laparotomy. Methods: A retrospectivo analysis of cases diagnosed and treated between 1991 and 2003 was conducted. All clinical charts of treated cases were reviewed. Results: Mature teratomas represented about 14% of ovarían tumors. The age of presentation was mainly at reproductive age (67%). Thirteen cases were diagnosed during pregnancy and eleven of them were found at the time of a cesarean section. The most frequent form of clinical presentation was as an incidental finding during clinical examination or pelvic ultrasound made while studying by other pathologies. In about a half of cases the chosen surgical approach was laparoscopy (LPX). In tumors biggerthan 9 cm, an open approach by laparotomy (LPE) was preferred (p<0.05). Independently of surgical approach, a conservative surgery was performed, usually an ovarían cystectomy or tumorectomy. For LPX group operative time was significantly longer (p<0.0007). However, analgesia requirements, the postoperati-ve starvation period, and time to hospital discharge were significantly shorter in this group compared with the LPE group (p<0.05). The incidence of complications was similar in both groups, the intraoperative rupture of teratoma was higher in the LPX group (26% vs. 12%, p=NS). Bilateralism and coexistence of malignant differentiation were 5.5% and less than 1 %, respectively. Conclusions: Our results support the laparoscopic approach in the management of mature teratoma of the ovary. Tumor size influences the medical decisión on surgical approach. Laparoscopy should be chosen with teratomas less than 9 cm. This approach offers similar outcome as obtained by laparotomy in terms of conservative surgery, complication rate and less requirement of analgesia, time in hospital stay and earlier labor reincorporation
