Doctors preparing for an operation

Ovarian Cysts

Ovarian cysts are solid or fluid-filled pockets (cysts) within or on the surface of the ovaries. Ovarian cysts are common, especially during reproductive ages. They are usually non-cancerous, diagnosed with the examination and ultrasound and most of them disappear without any treatment whilst others need surgery.

Most women will experience a cyst on their ovaries at least once in their lifetime. They generally cause no pain or symptoms and are discovered during a pelvic exam. As the cyst grows, women may experience pain, nausea, bloating, painful bowel movements or pain during sex. They are usually non-cancerous, but can sometimes cause serious problems, so it’s best to have them checked by a doctor. Some of them disappear without any treatment and others need surgery.

Types of ovarian cysts

  • Follicle cyst – If the follicle doesn’t break open, the fluid inside the follicle can form a cyst on the ovary.
  • Dermoid cysts – sac-like growths on the ovaries that can contain hair, fat, and other tissue
  • Cystadenomas – non-cancerous growths that can develop on the outer surface of the ovaries
  • Endometriomas (chocolate cyst) – tissues that normally grow inside the uterus can develop outside the uterus and attach to the ovaries, resulting in a cyst.

If we observe the cyst and it is small and simple, there will be no further management, meaning that only the sack will build up fluid and it is less than five centimetres. We would consider it to be a physiological or follicular cyst that develops as part of the normal function of the ovaries.

This is usually between five and seven centimetres and we will usually recheck with a pelvic ultrasound in about three months.

A large cyst, we would recommend surgery. The surgical treatment would also be recommended for smaller cysts which are not simple. For example, endometriomas, or dermoid cysts will be treated surgically.

Surgery may be recommended if you have a large cyst, cysts in both ovaries, or other characteristics that may suggest ovarian cancer. Ovarian cancer can occur in women of all ages, but the incidence increases after menopause.

Surgery is used to confirm the diagnosis of an ovarian cyst, remove a cyst that is causing symptoms, and rule out ovarian cancer.

Surgery for an ovarian cyst or growth may be advised in the following situations:

  • Ovarian growths (masses) are present in both ovaries.
  • An ovarian cyst is larger than 7 cm.
  • An ovarian cyst that is being watched does not get smaller or go away in 3 months.
  • An ultrasound exam suggests that a cyst is not a simple functional cyst.
  • You have ovarian growth and you:
    • Have never had a menstrual period (for example, a young girl).
    • Have been through menopause (postmenopausal woman).
    • Use birth control pills (unless you are using low-dose progestin-only pills or have missed a pill, which would make an ovulation-related functional cyst more likely).
  • Your doctor is concerned that ovarian cancer may be present. In this case, it is also advised that you see a gynecologic oncologist.

The surgery type would depend on the size and the type of the cyst but it would either be a laparotomy, also known as open surgery or a laparoscopy, also known as keyhole surgery. The size and type of the cyst, patients previous surgical history will determine the type of incision. 

Either type of surgery can be used to diagnose problems such as ovarian cysts, adhesions, fibroids, and pelvic infections.

The decision on the type of procedure to be performed is based on the type of pathology, risk of the pathology being cancerous, size of the lump. But if there is any concern about cancer or you have a very large cyst you may have a laparotomy. At times the decision is made to perform the surgery through a bigger cut because of the risk of spillage of the content of the cyst in the abdominal cavity. 

During surgery, a noncancerous cyst that is causing symptoms can be removed (cystectomy), leaving the ovary intact. In some cases, the entire ovary or both ovaries are removed, particularly when cancer is found or when women are in menopause.

Laparoscopy is a surgical technique in which a lighted viewing instrument (laparoscope) is inserted into the lower abdomen through a small incision, usually made through the belly button. The abdomen is inflated with CO2 gas, which pushes the wall of the abdomen away from the organs so the doctor can see them more clearly. Laparoscopy in comparison to laparotomy or open surgery, it leaves smaller scars, is often less risky, and usually requires a shorter recovery period.

During surgery, a noncancerous cyst that is causing symptoms can be removed (cystectomy), leaving the ovary intact. In some cases, the entire ovary or both ovaries are removed, particularly when cancer is found. In some cases, in menopausal women removing ovaries is the safest.

General anaesthesia is usually used during surgery.
After a laparoscopy, you will be in the hospital for a day or possibly overnight. You can resume normal activities within a day. But you should avoid strenuous activity or exercise for about one to two weeks.

An ovarian cyst can be removed from an ovary (cystectomy), preserving the ovary and your fertility. But it is possible for a new cyst to form on the same or opposite ovary after a cystectomy. New cysts can only be completely prevented by removing the ovaries (oophorectomy).

Risks of ovarian surgery include the following:

  • Ovarian cysts may come back after a cystectomy.
  • Pain may not be controlled.
  • Scar tissue (adhesions) may form at the surgical site, on the ovaries or fallopian tubes, or in the pelvis.
  • Infection may develop.
  • Bleeding can complicate surgery.
  • The bowel or bladder may be damaged during surgery.

Overall, it is a low risk surgery in most cases.

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