Elsevier

Journal of Minimally Invasive Gynecology

Volume 18, Issue 6, November–December 2011, Pages 720-725
Journal of Minimally Invasive Gynecology

Original Article
Management of a Persistent Adnexal Mass in Pregnancy: What Is the Ideal Surgical Approach?

Presented as a poster at the 56th Annual Meeting of the American College of Obstetricians and Gynecologists, New Orleans, Louisiana, May 3–7, 2008.
https://doi.org/10.1016/j.jmig.2011.07.002Get rights and content

Abstract

Study Objective

To compare short-term and pregnancy-related outcomes of laparoscopy with laparotomy for management of a persistent second-trimester adnexal mass.

Design

Retrospective cohort study of pregnant women at 14 weeks or more of gestation undergoing laparoscopy or laparotomy for management of an adnexal mass (Canadian Task Force classification II-2).

Setting

University hospital.

Patients

Women of reproductive age with a persistent adnexal mass at 14 weeks or more of gestation.

Intervention

Removal of adnexal mass via laparoscopy or laparotomy.

Measurements and Main Results

Between 1990 and 2008, 101 pregnant women underwent treatment of a persistent adnexal mass at 14 weeks or more of gestation at our institution. Fifty women underwent laparoscopy, and 51 underwent laparotomy. Similar demographic and adnexal mass characteristics were identified between the 2 surgical groups. Eight patients in the laparotomy group experienced postoperative complications, compared with none in the laparoscopy group (p < .02). Mean surgical estimated blood loss and length of hospital stay were significantly less in the laparoscopy group compared with the laparotomy group: 17.5 mL vs 100 mL (p < .001) and 0.7 days vs 2.78 days (p < .001), respectively. There were no observed differences in pregnancy-related outcomes between the 2 groups.

Conclusion

Minimally invasive surgery is a reasonable approach to management of a second-trimester adnexal mass in gravid women. Laparoscopy enables a shorter hospital stay, decreased blood loss, and fewer postoperative complications without seeming to have a negative effect on pregnancy-related outcomes. While these findings are reassuring, larger studies are encouraged to continue to evaluate this issue.

Section snippets

Materials and Methods

After approval by our institutional review board, we performed a retrospective cohort study comparing outcomes in patients who had undergone surgical management of an adnexal mass at 14 weeks or more of gestation. Data were collected for patients seen at our institution between January 1990 and January 2008. Patients were identified using the International Classification of Disease codes for adnexal mass or ovarian neoplasm and pregnancy or antepartum treatment. Both electronic and paper

Results

Between January 1990 and January 2007, 101 consecutive women were identified who underwent surgical management of a second-trimester adnexal mass at our hospital. Of these, 53 women underwent planned laparoscopy and 48 women underwent laparotomy. In the laparoscopy group, there were 3 conversions to laparotomy, and these cases are further considered in the laparotomy cohort. Of the women who underwent conversion to laparotomy, 1 patient had a cystic teratoma that could not be elevated out of

Discussion

In this retrospective study we report intraoperative and postoperative complications of surgically managed second-trimester adnexal masses. To our knowledge, this is the largest study to directly compare the 2 surgical approaches for management of a persistent adnexal mass at 14 weeks or more of gestation. Similar to previous smaller cases series, laparoscopic management of a second-trimester adnexal mass offered advantages over traditional abdominal laparotomy including less morbidity from the

References (19)

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The authors have no commercial, proprietary, or financial interest in the products or companies described in this article.

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