To the Editor,
Sir, we read with interest a case report by Einenkel et al.(1) on management of giant ovarian tumor. We would like to draw attention to certain issues.
In the authors’ case, tumor was removed in toto entering the abdominal cavity with an incision extending from xiphoid to pubis. We suggest intraoperative controlled drainage would have been a better option, abdomen being entered through an incision extending from umbilicus to pubis. After gently packing around the drainage site (as frozen section was suspicious of a mucinous cystadenoma), controlled drainage of the ovarian cyst could have been done. This will avoid the sudden release of pressure and hence circulatory depression as opposed to delivering the whole tumor. Author kept the patient in left lateral position in order to avoid the same. But it is very difficult to operate in such a position.
As we know, patients undergoing surgery for pelvic tumor are prone to develop venous thromboembolism. Authors could have used low molecular weight heparin prophylaxis in their case.
These comments aside, the authors should be commended on their results and we agree that preoperative drainage of the ovarian cyst should be discouraged as there are risks of infection, hemorrhage, and peritoneal adhesions making cyst removal even more difficult.