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Saxena AK, Mutanen A, Gorter R, Conforti A, Bagolan P, De Coppi P, Soyer T. European Paediatric Surgeons' Association Consensus Statement on the Management of Neonatal Ovarian Simple Cysts. Eur J Pediatr Surg 2024; 34:215-221. [PMID: 37557903 DOI: 10.1055/s-0043-1771211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
INTRODUCTION Neonatal ovarian simple cyst management from the pediatric surgical aspect is unclear on cyst size, follow-up, and preferred surgical approach. Therefore, this topic was selected for the 2022 Consensus Session meeting of the European Paediatric Surgeons' Association (EUPSA). METHODS The literature was reviewed on a predefined set of questions relating to the management of the neonatal ovarian simple cysts by a panel of 7 EUPSA members, on current evidence-based opinion and practice outlined. Each question (1) outcomes of fetal interventions in neonates after birth and consensus on size/timing of intervention, (2) consensus on the type of interventions, and (3) complications in neonatal ovarian cysts and follow-up recommendations in nonoperated/operated cysts, was presented with available evidence to congress session participants. The management approach was agreed by participants and comments were accounted to formulate the consensus statement. RESULTS There is still limited data on potential benefits and complications of prenatal ultrasound-guided aspiration; however, neonates after such procedures should be followed for 6 months. Neonates with simple ovarian cysts larger than 4 cm should be offered surgical interventions within the 2 weeks of life with complete laparoscopic cyst aspiration and fenestration with bipolar instruments being the preferred approach. Ultrasound follow-up after surgical intervention after 3 months and with the conservative approach after every 3 to 4 months until 1 year. CONCLUSION A peer-reviewed consensus statement for the management of neonatal ovarian simple cyst was formulated based on current evidence and peer practice. The EUPSA recognizes that the statement can be useful for pediatric surgeons in decision making for this pathology.
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Affiliation(s)
- Amulya K Saxena
- Department of Pediatric Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Annika Mutanen
- Department of Pediatric Surgery, University of Helsinki Children's Hospital, Helsinki, Finland
| | - Ramon Gorter
- Department of Pediatric Surgery, Emma Children's Hospital UMC, Amsterdam, the Netherlands
| | - Andrea Conforti
- Department of Medical and Surgical Neonatology, Bambino Gesu' Children's Hospital, Rome, Italy
| | - Pietro Bagolan
- Department of Medical and Surgical Neonatology, Bambino Gesu' Children's Hospital, Rome, Italy
| | - Paolo De Coppi
- Department of Paediatric Surgery, UCL Institute of Child Health, London, United Kingdom of Great Britain and Northern Ireland
- Department of Surgery, Great Ormond Street Hospital for Children, London, United Kingdom of Great Britain and Northern Ireland
| | - Tutku Soyer
- Department of Pediatric Surgery, Hacettepe Universitesi Tip Fakultesi, Ankara, Turkey
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Fetal Ovarian Cyst-A Scoping Review of the Data from the Last 10 Years. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020186. [PMID: 36837388 PMCID: PMC9959090 DOI: 10.3390/medicina59020186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 11/29/2022] [Accepted: 01/10/2023] [Indexed: 01/19/2023]
Abstract
Abdominal cystic masses are diagnosed during the intrauterine period and have a relatively low incidence. Fetal ovarian cysts are the most common form diagnosed prenatally or immediately after birth. The pathophysiology of the development of these types of tumors is not fully elucidated, with ovarian hyperstimulation caused by maternal and placental hormones being the most accepted hypothesis. During intrauterine development, the diagnosis of fetal ovarian cysts is most often made accidentally during usual check-up ultrasounds corresponding to the first, second, and third trimesters of pregnancy. We conducted a scoping review with the aim to map the current knowledge regarding the treatment of fetal ovarian cysts diagnosed in the intrauterine period. Focusing on the articles published in the last 10 years in the specialized literature, we tried to identify a conceptualization regarding the surveillance and treatment of these anomalies.
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Gynecological Problems in Newborns and Infants. J Clin Med 2021; 10:jcm10051071. [PMID: 33806632 PMCID: PMC7961508 DOI: 10.3390/jcm10051071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/28/2021] [Accepted: 03/02/2021] [Indexed: 11/17/2022] Open
Abstract
Pediatric-adolescent or developmental gynecology has been separated from general gynecology because of the unique issues that affect the development and anatomy of growing girls and young women. It deals with patients from the neonatal period until maturity. There are not many gynecological problems that can be diagnosed in newborns; however, some are typical of the neonatal period. This paper aims to discuss the most frequent gynecological issues in the neonatal period.
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Chiarenza SF, Conighi ML, Conforti A, Bleve C, Esposito C, Escolino M, Beretta F, Cheli M, Di Benedetto V, Scuderi MG, Casadio G, Marzaro M, Gambino M, Pini Prato A, Molinaro F, Gerocarni Nappo S, Caione P. Guidelines of the Italian Society of Videosurgery in Infancy (SIVI) for the minimally invasive treatment of fetal and neonatal ovarian cysts. LA PEDIATRIA MEDICA E CHIRURGICA 2020; 42. [PMID: 33140631 DOI: 10.4081/pmc.2020.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 10/08/2020] [Indexed: 11/23/2022] Open
Abstract
In the last three decades, fetal ovarian cysts were diagnosed more frequently, due to technological improvement and the increasing use of prenatal screening ultrasound. Nonetheless, treatment uncertainties are still present, either prenatally or postnatally. Recently, significant innovations on diagnosis and treatment have been proposed and a more conservative, minimally invasive approach may be offered to the Pediatrician or the Surgeon who face with this condition during prenatal or neonatal age. (...).
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Affiliation(s)
- Salvatore Fabio Chiarenza
- Pediatric Surgery and Urologic Unit, Regional Center of Minimally Invasive Surgery and Urology, S. Bortolo Hospital, Vicenza.
| | - Maria Luisa Conighi
- Pediatric Surgery and Urologic Unit, Regional Center of Minimally Invasive Surgery and Urology, S. Bortolo Hospital, Vicenza.
| | - Andrea Conforti
- Congenital Esophageal Disorders Unit, Neonatal Surgery Unit, Bambino Gesù Children's Research Hospital, Rome.
| | - Cosimo Bleve
- Pediatric Surgery and Urologic Unit, Regional Center of Minimally Invasive Surgery and Urology, S. Bortolo Hospital, Vicenza.
| | - Ciro Esposito
- Pediatric Surgery Unit, Federico II University, Naples.
| | | | | | - Maurizio Cheli
- Pediatric Surgery Department Papa Giovanni XXIII Hospital, Bergamo.
| | | | | | | | - Maurizio Marzaro
- Pediatric Surgery Unit, Local Health Unit 2, Treviso Hospital, Treviso.
| | - Marco Gambino
- Pediatric Surgery Unit, Annunziata Civil Hospital, Cosenza.
| | - Alessio Pini Prato
- Unit of Pediatric Surgery, The Children Hospital, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria.
| | - Francesco Molinaro
- Department of Medical Sciences, Surgery and Neuroscience, Section of Pediatric Surgery, University of Siena, Siena.
| | | | - Paolo Caione
- Pediatric Surgery and Urologic Unit, Pediatric Hospital Bambino Gesù, Rome.
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Approaches to the management of pediatric ovarian masses in the 21st century: Systematic review and meta-analysis. J Pediatr Surg 2020; 55:357-368. [PMID: 31706611 DOI: 10.1016/j.jpedsurg.2019.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 07/24/2019] [Accepted: 09/01/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Laparoscopy is increasingly being adopted for the treatment of ovarian pathologies in adults. However, its implementation for the management of pediatric ovarian masses varies and the evidence, to date, has not been comprehensively analyzed. This review aims to compare laparoscopic and open surgical management of pediatric ovarian masses. METHODS We searched PubMed, Cochrane Library and Google Scholar from the year 2000 till April 2017. Studies selected for this included those on epidemiological trends of pediatric ovarian lesions, assessing outcomes of laparoscopic management and comparison of laparoscopic and open surgical techniques for pediatric ovarian masses. A meta-analysis comparing outcomes of both modalities was performed using standard methodology. RESULTS A total of 44 studies met the inclusion criteria of which 15 were on histological types of ovarian lesions, 24 assessed laparoscopic management only and five compared laparoscopy with open surgery for pediatric ovarian masses. Nonneoplastic lesions were the most common ranging from 36.5% to 73.7%, with cystic lesions being the most prevalent. Neoplastic lesions ranged between 26.3% and 63.5%, with germ cell tumors being the most common, while malignancy ranged between 3.5% and 10.8%. Laparoscopic management was generally advocated for managing benign lesions with a cautious approach for suspicion of malignant lesions. In comparison to open surgery, laparoscopic surgery had shorter operating time (MD = -33.24 min, 95% CI = -34.29 to -32.19, p < 0.0001), less intraop bleeding (MD = - 61.46 ml, 95% CI = -62.69 to -60.24, p < 0.0001), and reduced length of hospital stay (MD = -2.78 days, 95% CI= -2.82 to -2.74, p<0.0001). Complication rates were equivocal between the two approaches. Spillage rates could not be assessed. CONCLUSION Limited evidence suggests that laparoscopic approach to presumptively benign ovarian masses have better outcomes when compared to open surgery with regards to operating time, blood loss and hospital stay. However, complication rates were similar between the two approaches. Studies with rigorous scientific methods are needed for a definitive recommendation, especially in resource limiting settings. However malignant lesions should still be managed with an open surgical approach to avoid upstaging of disease status. LEVEL OF EVIDENCE II.
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Rialon KL, Akinkuotu A, Fahy AS, Shelmerdine S, Traubici J, Chiu P. Management of ovarian lesions diagnosed during infancy. J Pediatr Surg 2019; 54:955-958. [PMID: 30795909 DOI: 10.1016/j.jpedsurg.2019.01.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 01/27/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Prior studies of infant ovarian cysts have recommended intervention for those larger than 4 cm. We reviewed the natural history and features of those managed operatively versus nonoperatively. METHODS A retrospective study was performed of ovarian lesions in children <1 year-old from 2000 to 2014. RESULTS Forty patients were identified. Twenty-eight (70%) underwent operative management, while 12 (30%) were managed conservatively, including one undergoing aspiration. The mean age at surgery was 125 days. All but one patient (96%) had evidence of antenatal torsion intraoperatively or on final pathology. All resected lesions were benign. Ultrasound findings more common in those undergoing surgery included intracystic debris (p < 0.001), fluid-fluid or fluid-debris levels (p = 0.002), absence of Doppler flow (p = 0.014), solid components (p = 0.04), and calcifications (p = 0.001). Cysts managed nonoperatively had an average diameter of 2.5 cm, compared to 5.1 cm in the operative group (p < 0.001). Three of the lesions managed nonoperatively had a diameter greater than 3.5 cm (mean 5.1 cm) and were followed for an average of 153 days until resolution. CONCLUSIONS The majority of infant ovarian lesions were excised, although none were malignant. Aspiration or observation of larger cysts was feasible and safe. Ovarian cysts in this age group should be considered for nonoperative management and closely followed. LEVEL OF EVIDENCE IIC.
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Affiliation(s)
- Kristy L Rialon
- Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Adesola Akinkuotu
- Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Aodhnait S Fahy
- Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Susan Shelmerdine
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Jeffrey Traubici
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Priscilla Chiu
- Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
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Sintim-Damoa A, Majmudar AS, Cohen HL, Parvey LS. Pediatric Ovarian Torsion: Spectrum of Imaging Findings. Radiographics 2017; 37:1892-1908. [DOI: 10.1148/rg.2017170026] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Akosua Sintim-Damoa
- From the Department of Radiology, LeBonheur Children’s Hospital, University of Tennessee Health Science Center, 848 Adams Ave, Memphis, TN 38103
| | - Anand Shyamcharan Majmudar
- From the Department of Radiology, LeBonheur Children’s Hospital, University of Tennessee Health Science Center, 848 Adams Ave, Memphis, TN 38103
| | - Harris L. Cohen
- From the Department of Radiology, LeBonheur Children’s Hospital, University of Tennessee Health Science Center, 848 Adams Ave, Memphis, TN 38103
| | - Louis Swig Parvey
- From the Department of Radiology, LeBonheur Children’s Hospital, University of Tennessee Health Science Center, 848 Adams Ave, Memphis, TN 38103
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