Surgery

Ovarian cyst surgery

Am I a candidate for ovarian cyst surgery?

Your surgeon may suggest ovarian cystectomy in the following cases:

  • Cyst is larger than 7.6 cm
  • Not a functional cyst
  • Cyst continues to grow
  • Cyst does not resolve within two to three menstrual cycles
  • Presence of pain or other symptoms
  • Exclusion of ovarian cancer
  • Cysts in both ovaries
  • Ovarian cysts present in:
  • Menarchal adolescents and adults
  • Post-menopausal women
  • Those using birth control pills

How do I prepare for ovarian cyst surgery?

Before ovarian cyst surgery, you will be advised to stop eating or drinking anything at least 6 hours before the procedure. Discuss all the medications that you are taking on a regular basis so that your doctor can advise you on the ones that you can safely continue and those that may need to be stopped during the time of surgery.

How are the different ovarian cyst surgeries performed?

Ovarian cyst surgeries can be performed by two approaches:

Laparoscopy

Two to 3 small incisions are made on your abdomen. Carbon dioxide gas is introduced to inflate your abdomen so that the surgical area can be viewed clearly. A laparoscope (a narrow lighted tube with a camera) is inserted through one of the incisions to guide your surgeon with the help of images relayed on a large monitor. Other surgical instruments are inserted through the other incisions.

Laparotomy

A single large incision is made on your abdomen to access the surgical site. This method is considered when large cysts need to be removed, and when the whole ovary or uterus must be removed.

Using these approaches, the different types of surgeries that can be performed are briefed below.

Ovarian cystectomy
Ovarian cystectomy is performed under general anaesthesia. The cysts are carefully excised from the ovary, ensuring the contents do not spill out. Once freed from the ovary, the cyst is opened and the contents aspirated to reduce its size. The deflated cyst is then removed through one of the abdominal incisions.
Alternatively, the intact cyst can be removed through the vagina or it can be collected and decompressed within a retrieval bag, minimising the chance of spillage of the cystÂ’s contents within the pelvic cavity.

Oophorectomy
The affected ovary is separated from the surrounding tissues and blood supply. It is either removed through the incision or it is placed in a pouch before removal.

Hysterectomy
Your surgeon separates the uterus from the surrounding organs and blood vessels, by ligating and sealing the open ends. The uterus is then removed via the abdominal incision or vagina. Along with the uterus, your surgeon will remove the ovaries as well.

What can I expect after ovarian cyst surgery?

Following ovarian cyst surgery, you will be given medication to relieve pain and discomfort. If a laparoscopic approach was done, you may experience back and shoulder pain as a result of the carbon dioxide gas used. This will resolve with time. You may also have spotting or vaginal discharge.

What are the advantages of ovarian cyst surgery?

The advantages of a laparoscopy over laparotomy are:

  • Smaller incisions
  • Reduced blood loss
  • Less scarring
  • Lower post-operative pain
  • Shorter hospital stay and recovery

Describe the stages of recovery and care plan

During your recovery, alert your doctor if you notice any of the symptoms below that may indicate an infection:

  • Severe pain or abdominal swelling
  • Fever
  • Heavy bleeding, or dark or smelly vaginal discharge

What are the outcomes of ovarian cyst surgery?

Ovarian cystectomy can help remove ovarian cysts while preserving fertility, but does not stop other cysts from forming.

What are the potential complications of ovarian cyst surgery?

As with most surgeries, ovarian cyst surgery may be associated with potential complications such as:

  • Bleeding
  • Infection
  • Damage to neighbouring organs such as bowel, ureters and bladder
  • Need for further surgery

What is the downtime of ovarian cyst surgery?

If you have undergone a laparoscopic procedure, you will be able to get back to your daily routine in about 2 weeks; however, you may require about 6 to 8 weeks following a laparotomy.

What is the prognosis of ovarian cyst surgery?

Since there are chances of recurrence, regular monitoring of the ovaries is advised.

What is the cost of ovarian cyst surgery?

Any costs involved will be discussed with you prior to your surgery.

What is the likelihood of ovarian cyst recurrence? How can it be managed?

There is a 6 to 10% risk of recurrence and would requires surgical removal of the cyst.

How can ovarian cysts be prevented?

Further formation of ovarian cysts can be prevented with the use of oral contraceptives., which also protect against ovarian cancer.

What is the current research regarding ovarian cysts?

Extensive research is being done to find better treatment options for ovarian cysts. Some of the recent studies are listed below:

  • Clark M, Zigras T, Bayat L, Kashani S. Minimally Invasive Non-Laparoscopic Ovarian Cystectomy: A Unique Way to Approach Large Ovarian Cysts. J Minim Invasive Gynecol. 2015 Nov-Dec;22(6S):S150.
  • Mehdizadeh Kashi A, Chaichian S, Ariana S, et al. The impact of laparoscopic cystectomy on ovarian reserve in patients with unilateral and bilateral endometrioma. Int J Gynaecol Obstet. 2017 Feb;136(2):200-204.

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