Title Neonatal ovarian cyst management Title (croatian) Liječenje novorođenačke ciste ovarija Author Mira Jennifer Vanessa Elisa Förster Mentor Stjepan Višnjić (mentor)Committee member Stjepan Višnjić (predsjednik povjerenstva)Committee member Tomislav Meštrović (član povjerenstva)Committee member Dinka Pavičić Baldani (član povjerenstva)Granter University of Zagreb Defense date and country 2020-07-17, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract OBJECTIVE: To assess the short-term surgical outcomes of treatment of neonatal ovarian cysts in the department of pediatric surgery at KDB Zagreb using two operative modalities - classical laparotomy and a hybrid approach (combination of laparoscopy and open surgery). The two treatment groups were compared with regards to operating times, length of hospital stay, time spent in the ICU, postoperative care and indications for surgery. Another goal was to investigate the criteria used for the neonatal ovarian cyst management and it included a third group of patients that were treated conservatively. ----- METHODS: A retrospective study was performed analyzing medical records of neonates that had been diagnosed and managed for neonatal ovarian cysts. Continuous numerical data was presented as mean ± SD or mean and range (minimum-maximum) and differences between groups compared using the two-sample t-test (assuming unequal variances) and the singlefactor ANOVA test. ----- RESULTS: The operating times were shorter in the hybrid group (44 ± 15 minutes) than in the laparotomy group (56 ± 18 minutes) but the difference was not statistically significant (p=0,23). The length of hospital stay was shorter in the hybrid group (7,2 ± 1,2 days) than in the laparotomy group (10,8 ± 3,1 days; p= 0,03). The time spent in the ICU was shorter in the hybrid group (0,4 ± 0,9 days) than in the laparotomy group (3,6 ± 2,5; p=0,02). Antibiotics, opioid analgesics, H2 blockers were not used in the postoperative care of the hybrid group and there were less changes in wound dressing and less CBCs were ordered in the hybrid group (1,0 ± 0,7) compared to the laparotomy group (4,4 ± 3,7). Indications for surgery were cyst size, either excessive (≥ 6 cm), persistent (≥ 4 cm) or an increase in cyst size (open: n=4; hybrid: n=3) and the presence of a complex cyst based on US findings (open: n=3; hybrid: n=2). There were significant differences in the cyst sizes on prenatal US in the 3 treatment groups (p=0,03). ----- CONCLUSION: Neonatal ovarian cysts can be safely and successfully managed surgically using a hybrid approach with better cosmetic results and better short-term postoperative outcomes than traditional laparotomy, given the proper indication for surgery.
Abstract (croatian) CILJ: Procijeniti kratkoročne kirurške ishode liječenja novorođenačke ciste jajnika, na odjelu dječje kirurgije KDB Zagreb koristeći dva operativna modaliteta - klasična laparotomija i hibridni pristup (kombinacija laparaskopije i otvorene kirurgije). Dvije skupine liječenja uspoređene su s obzirom na vrijeme trajanja boravka u bolnici, vrijeme provedeno u operativnoj njezi i indikacije za operaciju. Drugi cilj bilo je istražiti kriterije koji se koriste za liječenje novorođenačke ciste jajnika te je uključivao treću skupinu bolesnika koji su liječeni konzervativno. ----- METODE: Napravljena je retrospektivna studija kojom se analizirala medicinska evidencija novorođenčadi kod kojih su dijagnosticirane i liječene novorođenačke ciste jajnika. Kontinuirani numerički podaci prikazani su kao srednja ± SD ili srednja i raspon (minimalna - maksimalna) i razlike između skupina u usporedbi koristeći dva uzorka ispitivanja uz pretpostavku nejednakih varijacija i jednostruki faktor ANOVA test. ----- REZULTATI: Operaciona vremena su bila kraća u skupini za hibridni postupak (44 ± minuta) nego u skupini za laparotomiju (56 ± 18 minuta) ali razlika nije bila statistički značajna (p=0.23). Duljina bolničkog boravka bila je kraća u skupini s hibridnim postupkom (7,2 ± 1,2 dana) nego u skupini za laparotomiju (10,8 ± 3,1 dana; p=0,03). Vrijeme provedeno u jedinici za intenzivnu njegu bilo je kraće u skupini s hibridnim postupkom (0,4 ± 0,9 dana), nego u skupini za laparotomiju (3,6 ± 2,5; p=0,02). Antibiotici, opioidi, analgetici, H2 blokatori se nisu primjenjivali u postoperativnoj njezi skupine hibridnog postupka te je bilo manje potrebe za čestim previjanjem rana i manje KKS - a je naručeno u skupini za hibridni postupak (1,0 ± 0,7), u usporedbi sa skupinom laparotomije (4,4 ± 3,7). Indikacija za operaciju bile su veličine ciste, prekomjerna (≥ 6 cm), trajna (≥ 4 cm) ili povećanje veličine ciste (open: n=4; hibridna: n=3) i prisutnost složene ciste na temelju nalaza US (open: n=3; hibridna: n=2). Postojale su značajne razlike u veličini ciste na prentalnom US-u u 3 skupine
liječenja (p=0,03). ----- ZAKLJUČAK: Novorođenačke ciste jajnika mogu se sigurno i uspješno liječiti hibridnim pristupom s boljim kozmetičkim rezultatima i boljim kratkoročnim postoperativnim ishodima od tradicionalne laparotomije s obzirom na ispravne indikacije za operaciju.
Keywords
ovarian cyst
neonate
laparotomy
hybrid surgery
Keywords (croatian)
cista jajnika
novorođenče
laparotomija
hibridna kirurgija
Language english URN:NBN urn:nbn:hr:105:943688 Study programme Title: Medicine (in English language) Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2021-10-05 07:51:33
