MANEJO QUIRÚRGICO DEL TERATOMA MADURO: ¿LAPAROSCOPIA O LAPAROTOMÍA?

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    • Abstract:
      Objectives: To define selection criteria for surgical approach, laparoscopy or laparotomy. Methods: A retrospective 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 ovarian 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 bigger than 9 cm, an open approach by laparotomy (LPE) was preferred (p<0.05). Independently of surgical approach, a conservative surgery was performed, usually an ovarian cystectomy or tumorectomy. For LPX group operative time was significantly longer (p<0.0007). However, analgesia requirements, the postoperative 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 decision 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. [ABSTRACT FROM AUTHOR]
    • Abstract:
      Objetivos: Definir los criterios de selección para Ia via de abordaje por Iaparotomia versus laparoscopia. Método: Estudio retrospectivo de los casos de teratoma maduro manejados entre los años 1991 y 2003. Resultados: Los teratomas maduros corresponden aI 14% de los tumores ováricos. La edad de presenta- ción correspondió mayoritariamente a mujeres en edad reproductiva (67%). Trece casos se presentaron en embarazadas, 11 durante a cesárea. La presentación más frecuente fue como hallazgo cllnico o a Ia ultra-sonografla pelviana durante eI estudio por otra patologia. En Ia mitad de los casos el abordaje fue por via Ia-paroscópica (LPX). En tumores mayores de 9 cm, se privilegió Ia laparotomla (LPE) (p<0,05). Se privilegió Ia cirugia conservadora, habitualmente Ia tumorectomia o quistectomia. El grupo tratado via LPX registró un mayor tiempo operatorio (p<0,0007). Los requerimientos de analgesia, tiempo de ayuno postoperatorio y estadia hospitalaria fueron menores comparado con Ia via LPE (p<0,05). La incidencia de complicaciones postoperatorias fue similar en ambos grupos; Ia rotura intraoperatoria fue mayor en LPX (26% versus 12%, p=NS). Bilateralidad de 5,5% y coexistencia de diferenciación maligna menor a 1%. Gonclusiones: Nuestros resultados apoyan el abordaje Iaparoscópico para el tratamiento del teratoma maduro del ovario, en tumores menores de 9 cm esta debiese ser de elección. Ofrece similares tasas de éxito que Ia IaparotomIa en términos de cirugia conservadora y complicaciones, con menor requerimiento de analgesia, menor estadia hospitalaria y reintegro laboral precoz. [ABSTRACT FROM AUTHOR]
    • Abstract:
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