Laparoscopy Versus Laparotomy for Surgical Management of Ovarian Dermoid Cysts in Children: A Systematic Review and Meta-Analysis.

STUDY

OBJECTIVE

To compare intraoperative cyst rupture, peritonitis, and cyst recurrence after ovarian dermoid surgery via laparoscopy versus laparotomy in pediatric and adolescent patients.

METHODS

A comprehensive systematic review and meta-analysis was conducted following PRISMA guidelines and the Cochrane Handbook for Systematic Reviews. Five bibliographic databases (MEDLINE, Embase, Cochrane CENTRAL, Cochrane Database of Systematic Reviews, Web of Science) and 3 clinical trial registries were searched from inception to August 29, 2024. Eligible studies included quasi-randomized trials and prospective/retrospective cohort studies evaluating intraoperative cyst rupture, peritonitis, or cyst recurrence after laparoscopy versus laparotomy for ovarian dermoid surgery. Two authors independently performed title-abstract and full text screening and independently extracted data. Meta-analyses of cyst rupture and cyst recurrence after laparoscopy versus laparotomy for ovarian dermoid surgery were performed and presented in forest plots. Risk ratios for cyst rupture were pooled with a random-effects model, and for cyst recurrence were pooled with a fixed-effect model. Quality assessment was assessed using the Newcastle-Ottawa Scale.

RESULTS

A total of 1021 studies were identified, with 6 studies included (2000-2022; Canada, United States, Poland). We included 481 (53.9%) patients who underwent laparoscopy, 353 (39.5%) who underwent laparotomy, and 59 (6.6%) who underwent laparoscopy converted to laparotomy. For meta-analysis, 5 studies were included for cyst rupture, and 4 studies were included for cyst recurrence. Random-effects meta-analysis demonstrated a significantly higher risk of cyst rupture with laparoscopy (RR = 2.47; 95% CI, 1.40-4.37). Fixed-effect meta-analysis found no significant difference in cyst recurrence between laparoscopy and laparotomy (RR = 0.92; 95% CI, 0.41-2.08). No cases of chemical peritonitis were observed.

CONCLUSION

For the surgical management of ovarian dermoid cysts in children, laparoscopy may carry a higher risk of intraoperative cyst rupture compared to laparotomy, however our work highlights that subsequent post-operative peritonitis was not clinically observed and recurrence rates remained similar.