Laparoscopic management of benign adnexal masses: experience in a developing country

Objective To compare the efficacy, cost-effectiveness, and possible complications of operative laparoscopy with laparotomy for treating benign adnexal cystic tumours at a unit in a developing country. Design A prospective comparative study. Setting Gynaecologic Endoscopy Unit, Assiut University Hospital, Assiut, Egypt. Subjects 91 women of childbearing age with a clinical, biochemical and transvaginal sonographic diagnosis of benign adnexal cystic tumour. Interventions 71 patients were allocated to one of two groups according to management approach. The laparoscopy group (A) included 37 patients while the laparotomy group (B) included 34 patients. Main outcome measures For each patient, the operating time, intra- and postoperative complications, postoperative pain and duration of hospital stay were recorded. Results The operating time was significantly shorter in group A (47.8 +/- 28.3 min) than in group B (64.9 +/- 19.2 min). Intraoperative uncontrolled bleeding occurred in one patient in group A. Postoperative pain was significantly less in group A than in group B (P < 0.001). Postoperative febrile morbidity developed in 12.2% and 31.6% of patients in groups A and B, respectively. The duration of postoperative hospital stay was significantly shorter among patients in group A (49.5 +/- 42.6 h) than in group B (124.8 +/- 40.9 h) (P < 0.001). Postoperative complications included wound infections: one case in group A and three in group B. Conclusions Laparoscopic management of benign cystic adnexal masses is a fast and safe procedure with minimal intra- and postoperative complications compared with laparotomy. Its use in developing countries with limited resources is cost-effective, given appropriate selection of cases and experienced endoscopists.