Factors that increase the risk of leakage during surgical removal of benign cystic teratomas.

The contents of mature cystic teratomas can be a potent irritant resulting in chemical peritonitis. Using a retrospective cohort, we examined the various risk factors for leakage of benign cystic teratomas during laparoscopy and laparotomy. Cyst leakage of the benign cystic teratoma contents was the primary endpoint. In all, 158 women underwent surgery for a total of 178 ovarian benign cystic teratomas. Statistical analysis was performed using chi(2), Mann-Whitney U and multivariate logistic regression analysis. A total of 115 benign cystic teratomas was successfully removed without intra-operative leakage and 63 underwent intra-operative leakage either at laparoscopy or laparotomy. The likelihood of success of removing the benign cystic teratoma intact was unrelated to age, pre-operative size or surgical technique. There was no difference among cystectomies performed by laparotomy in surgeon experience or the presence of adhesions. However, surgeons with more laparoscopic experience (>35 laparoscopies/year) were less likely to have intra-operative leakage (relative risk: 0.5, 95% confidence interval: 0.2, 1.2) compared to surgeons with less experience (<20/year) at cystectomy (26.1 versus 51.2% respectively). Oophorectomy significantly reduced the frequency of intra-operative leakage at both laparoscopy and laparotomy (14.7%). These findings suggest that laparoscopic experience can reduce the risk of leakage at cystectomy. At laparotomy, lack of surgeon postgraduate years of experience was not a risk factor for leakage.