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J Pediatr Adolesc Gynecol. 2017 Feb;30(1):123-127. doi: 10.1016/j.jpag.2016.09.002. Epub 2016 Sep 14.

Surgical Management of Benign Adnexal Masses in the Pediatric/Adolescent Population: An 11-Year Review.

Author information

1
Department of Obstetrics and Gynecology, Washington University School of Medicine, Saint Louis, Missouri. Electronic address: BergeronL@wudosis.wustl.edu.
2
Department of Obstetrics and Gynecology, Washington University School of Medicine, Saint Louis, Missouri.
3
Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana.

Abstract

STUDY OBJECTIVE:

The purpose of this study was to compare ovarian conservation rates and surgical approach in benign adnexal surgeries performed by surgeons vs gynecologists at a tertiary care institution.

DESIGN:

A retrospective cohort review.

SETTING:

Children's and adult tertiary care university-based hospital.

PARTICIPANTS:

Patients 21 years of age and younger who underwent surgery for an adnexal mass from January 2003 through December 2013.

INTERVENTIONS:

Patient age, demographic characteristics, menarchal status, clinical symptoms, radiologic imaging, timing of surgery, surgeon specialty, mode of surgery, rate of ovarian conservation, and pathology were recorded. Patients were excluded if they had a uterine anomaly or pathology-proven malignancy.

MAIN OUTCOME MEASURES:

The primary outcome was the rate of ovarian conservation relative to surgical specialty; secondary outcome was surgical approach relative to surgical specialty.

RESULTS:

Of 310 potential cases, 194 met inclusion criteria. Gynecologists were more likely than surgeons to conserve the ovary (80% vs 63%; odds ratio, 2.28; 95% confidence interval, 1.16-4.48). After adjusting for age, body mass index, mass size, and urgency of surgery, the difference was attenuated (adjusted odds ratio, 1.84; 95% confidence interval, 0.88-3.84). Surgeons and gynecologists performed minimally invasive surgery at similar rates (62% vs 50%; P = .11). A patient was more likely to receive surgery by a gynecologist if she was older (P < .001) and postmenarchal (P = .005).

CONCLUSION:

Results of our study suggest that gynecologists are more likely to perform ovarian-conserving surgery. However, our sample size precluded precise estimates in our multivariable model. Educational efforts among all pediatric and gynecologic surgeons should emphasize ovarian conservation and fertility preservation whenever possible.

KEYWORDS:

Adnexal mass; Adnexal torsion; Adolescent; Laparoscopy; Ovarian conservation; Pediatric

PMID:
27639749
DOI:
10.1016/j.jpag.2016.09.002
[Indexed for MEDLINE]
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