What is the recommended treatment for a dermoid cyst on the ovary?

Treatment of Dermoid Cysts on the Ovary

Fertility-preserving surgery is the recommended treatment for ovarian dermoid cysts, with laparoscopic cystectomy being the preferred surgical approach due to its safety, effectiveness, and reduced recovery time compared to laparotomy. 1

Understanding Dermoid Cysts

Dermoid cysts (mature teratomas) are:

• The most common type of ovarian tumor, accounting for approximately 20% of all ovarian tumors 1
• Usually benign in nature
• Characterized by their distinctive appearance on imaging, often containing hair, teeth, and cartilage 1
• Most commonly found in younger women 1

Diagnostic Approach

Before treatment, proper diagnosis is essential:

• MRI is particularly valuable as it can identify pathognomonic signs of dermoid cysts including fatty and calciferous content 1
• Tumor markers (AFP, β-hCG, LDH) should be measured, although they may not always be helpful for dermoid cysts specifically 1
• Ultrasound can also identify characteristic features of dermoid cysts 1

Surgical Management Algorithm

For Young Women (Reproductive Age)

1. Conservative, fertility-preserving surgery is strongly recommended 1

   • Laparoscopic cystectomy is the procedure of choice 2, 3
   • Ovarian tissue should be preserved whenever possible 1
   • Full staging procedures should be avoided as they are unnecessary 1

2. Surgical technique considerations:

   • Use of endoscopic impermeable sack for intact cyst removal can prevent peritoneal contamination 2
   • If spillage occurs, thorough peritoneal washing with Ringer's lactate solution is essential 3
   • Peritoneal drainage for 24-48 hours is recommended if cyst contents spill 3

For Postmenopausal Women

• Standard surgical approach (may include oophorectomy) is appropriate 1
• The decision between laparoscopy and laparotomy should still favor laparoscopy when technically feasible 4, 5

Benefits of Laparoscopic Approach

Laparoscopic removal offers significant advantages over laparotomy:

• Significantly less blood loss (58.64±30.17 ml vs. 103.84±38.45 ml) 4
• Shorter hospitalization (3.18±0.39 days vs. 6.32±1.09 days) 4
• Reduced post-surgical pain 4
• Fewer post-surgical complications 4
• Faster recovery 4

Managing Potential Complications

Chemical Peritonitis Prevention

Despite concerns about chemical peritonitis from cyst spillage:

• Studies show that with proper technique, the risk is minimal 3, 5
• Key preventive measures include:
  • Use of endoscopic bags for extraction 2
  • Thorough peritoneal lavage if spillage occurs 3, 5
  • Peritoneal drainage when indicated 3

Recurrence Risk

• The risk of recurrence after conservative treatment is approximately 4% 2
• Regular follow-up is recommended to monitor for recurrence

Alternative Approaches

For selected cases, vaginal removal with laparoscopic assistance may be considered:

• May offer advantages in operating time and reduced intraperitoneal spillage 6
• Can be a safe alternative to total laparoscopic removal 6

Follow-up Recommendations

Regular follow-up is essential after conservative treatment:

• Imaging surveillance to detect early recurrence
• No specific adjuvant treatment is required for benign dermoid cysts 1

In rare cases of malignant transformation (0.1-0.3% of dermoid cysts), additional treatment would be necessary, but this is extremely uncommon 1.