SURGICAL MANAGEMENT OF ADNEXAL MASSES: LAPAROSCOPIC VERSUS OPEN APPROACH – DIAGNOSTIC YIELD, COMPLICATIONS, AND HOSPITAL STAY

Abstract

Background: Adnexal masses are typical gynaecological pathologies, which comprise functional cysts and neoplastic lesions. Even though imaging modalities can be used to help in preoperative assessment, surgical diagnosis is generally made by the use of histopathological studies. Historically laparotomy has been the surgery method but lately laparoscopy has become more popular because of its Non-invasive characteristics and possible advantage of less postoperative pain, quicker recovery and the decreased duration of hospitalization. Although these are the strengths, there is still an issue of concern about the time of operation, intraoperative complications and diagnostic adequacy. Local tertiary care setting comparative data is limited.

Objective: To compare laparoscopic and open surgical approaches in the management of adnexal masses in terms of diagnostic yield, perioperative complications, and duration of hospital stay.

Methods: This prospective comparative study was conducted at a  Sir Ganga Ram Hospital, Lahore from January 2023 to July 2023. A total of 124 patients aged 18–65 years diagnosed with adnexal masses requiring surgical intervention were included. Patients were allocated into two groups: laparoscopic surgery (n=64) and open laparotomy (n=60). Inclusion criteria comprised benign or suspected benign adnexal masses based on clinical examination and imaging findings. Patients with confirmed malignancy, pregnancy, hemodynamic instability, or severe systemic illness were excluded. Data regarding operative time, intraoperative blood loss, histopathological diagnosis, postoperative complications, and length of hospital stay were recorded and analyzed statistically.

Results: Laparoscopic surgery demonstrated significantly lower intraoperative blood loss and reduced postoperative complications compared to laparotomy. The complication rate was 9.3% in the laparoscopic group versus 21.6% in the open surgery group. Mean hospital stay was significantly shorter in the laparoscopic group (2.1±0.8 days) compared to the laparotomy group (4.8±1.3 days). Operative time was slightly longer in the laparoscopic group. Diagnostic yield based on histopathological correlation was comparable between both approaches.

Conclusion: Laparoscopic surgery of adnexal masses offers the same level of diagnostic accuracy at reduced morbidity and hospital stay in comparison to open surgery. It must be regarded as the surgical modality of choice among the patients who are selected properly.