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Summary

Ovaries are egg-producing reproductive organs that are usually present in a pair in the lower belly of women. In the process of releasing the egg from the ovaries, small cysts are formed every month, which disappear in a few weeks to months. However, some cysts may not dissolve on their own and persist for longer periods of time. These cysts may grow in size and cause symptoms like pain, weakness, bloating, and may even be cancerous. Some of these cysts may also cause rotation of the ovary, which can cut off its blood supply and cause its death. In such cases, removing the cyst by surgery is recommended. Around 7% of women worldwide have ovarian cysts at some point in their life. The surgery may be conducted in two ways - laparoscopy (less invasive and close surgery) and laparotomy (more invasive and open surgery). 

Before surgery, you may have to undergo a few tests to ensure your fitness for surgery, such as blood tests, urine test, ultrasonography and so on. Once the cyst is removed, you will be discharged and few medications will be given to be taken on a regular basis for faster healing. A few complications may arise after surgery that includes fever, vomiting, vaginal bleeding, not being able to bear children, and so on. These risks, however, will be explained to you well in advance by your doctor. 

  1. What is an ovarian cyst removal (cystectomy) surgery
  2. Why is ovarian cyst removal surgery done
  3. Preparations before cystectomy
  4. How is ovarian cyst removal surgery done
  5. Post-surgical care
  6. Precautions to take after surgery
  7. Risks and complications of cystectomy
  8. Recovery period after cystectomy
  9. Outcome of ovarian cyst removal surgery
  10. Follow-up after ovarian cyst removal surgery

Ovarian cysts are fluid-filled pouches or sacs that develop in the egg-producing organs (ovaries) of women. An ovarian cancer surgery, also known as cystectomy, is a procedure that is employed to remove these persistent cysts. The surgery can be performed in two ways based on the size and number of cysts, your overall health, and the availability of treatment options.

The cysts can be removed either by taking them out through a large cut in the belly (laparotomy) or through multiple small cuts using a small lit tube with a camera attached at one of its ends (laparoscopy). Laparotomy is preferred for cysts that are larger in size and cannot be removed through laparoscopy. Usually, the latter is preferred as it is less invasive, less painful and you can go home on the same day after the procedure is complete.

Ovarian cysts are very common and develop on a monthly basis (functional cysts) as part of the regular menstrual cycle and disappear in a few months. However, some cysts may persist and become bigger in size with time (pathological cysts). These cysts cause discomfort, such as: 

In some cases, these cysts may also become cancerous and spread to the adjacent tubes that carry the eggs to the womb (fallopian tubes) and the womb itself. In other cases, these cysts may cause rotation or torsion of the ovary, which is a dangerous condition and needs to be addressed surgically as soon as possible. Thus, their removal becomes necessary so that you get rid of all these symptoms and live a healthy life.

Before you go in for surgery, your doctor will do a general physical full-body and lower belly examination to check for the areas from where the symptoms arise. He/She will also advise you to undergo a few tests to ensure that you’re fit for the procedure to be carried out and might ask you a few questions regarding your:

  • Age
  • Last monthly period 
  • Previous or current pregnancy status
  • Other previous surgeries and their complications, if any.
  • Any underlying disease for which you are currently receiving treatment or medications. 
  • Hormone therapy or other methods of contraception that you are using, and so on.

The tests that may be advised are:

  • Complete blood count
    CBC test is done to check the amount of haemoglobin, blood cell count, and infection-fighting cell count.
  • Urine tests
    Urine test is advised to check for any abnormal secretions, hCG (pregnancy hormone) and kidney function.
  • Hormone tests
    The levels of reproductive hormones in the blood serum may also be tested to check if there is any of them are abnormally high or low. These hormones are LH, FSH, estradiol, and testosterone.
  • Heart tests
    Specific tests to check heart function, such as ECG (electrocardiograph).
  • Ultrasonography (USG)
    USG, especially the endovaginal USG with Doppler effect is often employed to examine which type of cyst you have and suspect its cancerous nature. In an endovaginal USG, a slender device is entered into the vagina, which sends ultrasound waves that are caught back by the same device, sends signals to a computer screen and the doctor can see the images on it.
  • CA-125 test
    This is a type of screening tests to examine the presence of cancer if your ultrasound reports are not normal or if you have attained menopause (a stage when a woman stops menstruating after a certain age).
  • Other tests
    A few other tests that may be prescribed besides the ones mentioned above are MRI (Magnetic Resonance Imaging) and CT scan.

Once all the reports are out and you’re found fit to undergo the procedure, your doctor will fix the date of surgery and give you instructions for the same, which are discussed below:

  • Do not to eat or drink on the night before the surgery. 
  • If any medications are to be taken, take them with small sips of water.
  • If you are taking any blood-thinning medications for any heart diseases, consult your physician and get his/her consent for stopping the medication at least a week before the surgery and carrying out the procedure.
  • On the day of surgery, you will be given a germ-free gown to be worn before the procedure once you are ready to go in.
  • A full body examination along with a few tests may also be carried out again on that day. The surgeon will check your pulse, body temperature, blood pressure and breathing rate. These vitals will be monitored throughout the procedure. 
  • You may also be tested for the type of numbing agent (anaesthesia) that would suit you best and give a good amount of time for the procedure to be carried out. 

The treatment of ovarian cysts depends upon the size and appearance of the cyst, associated symptoms and their severity and the status of your monthly menstrual cycles. 

Watchful Waiting

Watchful waiting is the most commonly employed policy in the management of ovarian cysts. Your doctor may advise you to wait and see if the cyst disappears on its own after a few months. For this, you may be advised to get yourself checked regularly and undergo ultrasonography a few weeks or months since the diagnosis. If you have attained menopause, you might be advised to get an ultrasonography and blood test done every four to six months in a year. This is because women with menopause have a greater risk of getting ovarian cysts of cancerous type and ovarian cancer.

Medication

Medications are usually prescribed when there is an underlying cause of ovarian cyst formation, such as polycystic ovarian syndrome (PCOS).

Surgery

If the cyst is persistent and has started worsening your condition, surgery may be advised to get the cyst removed. However, based on the affected area, three procedures may be performed, which include:

  • Ovarian cystectomy
    Removal of the cyst from the ovary or ovaries.
  • Oophorectomy
    Removal of the affected ovary. This is usually done when the entire ovary is filled with cyst or cysts. 
  • Total hysterectomy
    Sometimes, the cysts may extend and start developing into the uterus. In such cases, removal of the uterus might be the only option to get rid of the cysts and relieve you from symptoms. This is known as a total hysterectomy

To carry out the procedure, one of the following approaches may be employed:

  • Laparoscopy
  • Laparotomy

Laparoscopy

When the cyst is giant, laparoscopy is considered a safe and less invasive procedure for removing the cyst. The procedure is carried out by making you fall asleep using numbing agents. It is preferred over laparotomy because the recovery time is less after the procedure. 

Laparoscopy is a keyhole surgery because the size of cuts made into your lower belly to carry out the surgery is very small. The stepwise procedure is discussed below:

  • Small cuts or incisions will be made in your pelvis or the lower belly region. 
  • Your tummy will be inflated by blowing gas so that the surgeon can access your ovaries easily. 
  • A small, slender, tube-like device with a lit camera on one end will be entered in one of the holes and the insides of your lower belly will be viewed on a screen. 
  • Through the other cuts, the surgeon will pass surgical instruments. Using these instruments, the cyst is taken out from one of the holes and sent for testing in the lab. 
  • The surgical cuts will be stitched back using strong and dissolvable threads. 

Laparotomy

A laparotomy is advised when the cyst is too large to be taken out using a laparoscope or is cancerous. This procedure involves the following steps:

  • A single large cut will be made in your lower belly. 
  • The cyst is taken out and sent to the lab for testing. 
  • If it is cancerous, some of the surrounding healthy tissues will be removed to ensure no cancer cell is left inside the body.
  • The cut will be closed with the help of stitches and staples. 
  • A few days of hospital stay may be required. 

If you have undergone a laparoscopy, you will be discharged on the same day and you can recover at home. However, in a laparotomy, you’ll have to stay in the hospital for a few days after surgery. Once the effect of anaesthesia wears off, you will be shifted to the recovery room and will be taken care of as per your doctor’s instructions, such as:

  • Giving antibiotics and painkiller medications on time and as prescribed.
  • Dressing of the surgical area will be done by a nurse or doctor or your family member after receiving proper guidance from your doctor.
  • Undergoing the tests if they were advised right after surgery.
  • Your vitals will be monitored till you are in the hospital and your healing status will be evaluated. 

Once you are discharged, you will have to take care of a few things which are advised to be avoided during the recovery period, such as:

  • Avoid lifting children or heavy weights as this may put a strain on the surgical area as a result of which your stitches may open or the skin may get stretched.
  • It is also advised not to do strenuous exercise as there is a possibility of injuring yourself.
  • Remove any slippery mats or rugs and even slippers without a good grip. These may cause accidental falls and you may get hurt.
  • If you are facing difficulties in sitting, standing or walking around the house,  get grab bars installed in your house that will aid in walking.
  • Do not eat spicy or junk food. The nutrition that your body needs for healing is not provided by such food items. Also, spicy food hinders with the healing process.   
  • Avoid sleeping on the side of the operation. Either sleep on the other side or on your back. This will prevent any undue pressure on the wound.
  • Do not touch the wound with dirty hands and always use the prescribed medicine for applying a dressing. 
  • Avoid taking any traditional herbs or alternative medicine prescriptions as they may either hinder the effect of the medicines prescribed by your procedure or even react with them, which can be harmful.

Certain risks and complications are associated with this surgery, which may be seen during or after the procedure. 

During surgery

  • When the removal of the cyst isn’t possible by laparoscopy or due to any other unforeseen events, the surgeon might have to switch to laparotomy to remove the cysts. As a result, the surgery might get prolonged and a large cut will be made to remove the cyst.
  • During surgery, in a few cases, injury to an adjacent important nerve or blood vessel may occur leading to their damage.
  • Since the digestive and urinary systems lie close to the ovaries, injury to the organs of these systems, such as the ureter and small intestine may occur in the form of perforation may occur in a very few cases.

After surgery

A few complications that may be seen after surgery include:

  • Fever and wound infection
  • Body weakness
  • Irregular menstrual cycles
  • In the case of hysterectomy, you will not be able to bear children in future.
  • Recurrence of the cyst.
  • Bleeding from the surgical site.
  • Abnormal vaginal bleeding or foul-smelling discharge.

The recovery period not only depends on the type and extent of surgery but also on how good you take care of yourself while healing. For faster recovery, you might want to follow a few things that we’ve discussed below: 

  • Increase the level of physical activity gradually. Start by taking short walks every day and later, go for long walks. Physical activity increases blood circulation and helps the wound heal faster.
  • Take an adequate amount of sleep and do not be awake for too late.
  • Ask your doctor about when you can start taking a shower. Use a bucket or shower to take a bath and avoid soaking in bathtubs. 
  • Wear clean and loose clothes with cotton fabric. 

The outcome of cystectomy is usually good. It not only depends on the size of the cyst but also on whether one or both ovaries are involved. Let’s look at the possible outcomes of the surgery:

  • In case both ovaries are to be removed, you will immediately have menopause after surgery and won’t be able to bear children naturally. However, artificial ways may be employed to conceive.
  • In case a total hysterectomy is done, it won’t be possible for you to bear children.
  • In some cases, the cyst may form again or a new cyst may develop. Depending on the nature and size of the cyst, another surgery may or may not be recommended.
  • The outcome is not good in women who have underlying diseases that lead to cyst formation, such as polycystic ovarian syndrome. In such cases, medications are prescribed along with lifestyle changes to control the condition. 

Once the procedure is done, your doctor will instruct you on regular follow-ups to ensure:

  • The wound has completely healed.
  • There are no signs of cyst leftovers. For this, you may have to undergo ultrasonography.
  • No other cyst has developed adjacent to the one removed or in another ovary.
  • You get screened for cancer every 4-6 months if you do not get your periods or have attained menopause. 
  • You undergo regular chemotherapy and radiotherapy in case your cyst was cancerous. 

Follow-ups are usually scheduled, but in case you have any of the below-mentioned symptoms, go see your doctor immediately:

Severe pain at the site of surgery.

  • Fever.
  • Vomiting.
  • Discomfort in your belly.
  • Excessive weakness.
  • Breathlessness.
  • Heavy bleeding from the vagina.
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References

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