Ovarian cysts

An ovarian cyst is a fluid-filled pouch (sac) on or within the ovary. Most young women develop small and vanishing ovarian cysts at one point in their life, and about 8% of them grow large enough to cause problems. Ovarian cysts may also be present in about 16% of women after menopause; when they require thorough evaluation.

Ovarian cysts may be either totally asymptomatic and harmless and just a chance finding on sonography done for other purpose or they cause agonizing pain due to twisting; may make a woman‘s chance of getting pregnant difficult or maybe having an increased risk of turning into cancer.

Ovarian cysts are of many types; the majority of them do not require any treatment and can be just observed. While the noncancerous ovarian cysts which require surgery are quite amenable to treatment by laparoscopy. Dr. Dimple Doshi at NABH accredited Vardaan Hospital is an expert for ovarian cysts like dermoid cysts, endometriotic cysts or chocolate cysts, and other cysts. Dr. Dimple Doshi has experience of treating ovarian cysts by laparoscopy with maximum preservation of ovarian function which carries so much significance as ovaries are extremely important for the general health of women; their feminity and their ability to get pregnant in the future.

Dr. Dimple Doshi at Vardaan Hospital; believes prevention is better than cure, and thus apart from the precise treatment guidelines; preventive measures are an essential part of our consultations with the patients who have either had it or want to know more about it.

Functional ovarian cysts: ( The ovarian cyst which develops due to ovulation process.)

1.         Follicular cysts

2.         Corpus luteal cyst

3.         Theca lutein cyst

Non functional cyst: (The ovarian cyst which does not develop as a result of ovarian function)

1.         Chocolate cysts

2.         Hemorrhagic ovarian cyst

3.         Dermoid cyst

4.         Serous cystadenoama cyst

5.         Mucinous cystadenoma

6.         Paraovarian cysts

7.         Borderline tumors

Many ovarian cysts may not cause any symptoms.

The symptomatic ovarian cysts may cause:

1.         Lower abdominal pain

2.         Pain during sexual intercourse.

3.         Irregular periods

4.         Fullness, heaviness, pressure or bloating in the lower abdomen.

5.         Sudden sharp pain in lower abdomen if ovarian cyst ruptures or gets twisted. . Twisting of an ovarian cyst is an emergency condition which if not treated on time, may lead to serious consequences.

6.         Frequency of urine or difficulty with bowel movements due to pressure by a large ovarian cyst

7.         Fatigue, nausea, vomiting.

1.         Ovarian cyst can be diagnosed by regular physical examination by your gynecologist. Your gynecologist will do the internal check-up and may feel the lump in the pelvis, and thus the presence of an ovarian cyst is suspected.  

2.         Ultrasonography will exactly measure the size and the type of ovarian cyst.

3.         Still if there is any diagnostic difficulty about the nature of the cyst and for the confirmation of its noncancerous type, further investigation like CT scan or MRI may be performed.

4.         Special blood reports like serum Ca 125, CEA, HE4, ROMA index are also other tests that can differentiate a benign from a cancerous ovarian cyst.

Conservative:

Wait and watch No active treatment is required as majority of the ovarian cysts are benign and resolve on their own.

Medicines

Medicines may be used to control the symptoms of ovarian cysts. Medicines are given to reduce pain. Cyclic hormonal contraceptives are used to suppress the existing ovarian cyst or to prevent the development of new ovarian cysts.

SURGERY

The indications for surgery are:
  1. Ovariancysts that persist beyond 2 to 3 menstrual cycles
  2. Ovariancyst which occur in post menopausal women.
  3. Ovariancysts which persist for  longer duration and cause symptoms either due to pressure on the surrounding organs or twisting
  4. Complex ovariancysts more than 5 cm in size
  5. Simple ovariancysts larger than 10 cm or larger than 5 cm in menopausal patients.
  6. Ovariancysts which have undergone twisting
  7. Ovariancysts which increase in size.
  8. Ovariancyst which has a very high risk of getting cancerous.
  9. Dermoid cyst
  10. Big chocolate cystsor even the smaller chocolate cysts causing infertility.

No, you cannot prevent functional ovarian cysts if you are ovulating. If you get ovarian cysts often, your doctor may prescribe hormonal birth control pills to stop you from ovulating. This will help lower your risk of getting new cysts.

The condition known as PCOS  is preventable by adopting a healthier life style with an emphasis on nutritious diet and exercise.

  1. Very large ovariancyst
  2. Patient not fit to undergo laparoscopic surgery for ovariancyst
  3. Probable chance of malignancy or borderline nature.

Ovarian cyst surgery by open method:

Open surgery for ovarian cyst allow your surgeon to feel the ovarian cyst and surrounding structures; and allows your surgeon to remove the ovarian cyst without spilling inside the abdomen.  

Anesthesia: Spinal or general

Incision: 5 to 10 cm long

After the patient is anesthetized and given the incision; your surgeon will carefully lift the ovarian cyst  after cordoning off the area from the underlying structures ; enucleate it completely and remove without spilling any contents. The ovarian cyst after removal is sent for histopathological examination.

Sometimes after opening up the abdomen; if there is a suspicion of the cyst  being cancerous; a special test called frozen section is done and based on that instant report of the ovarian cst being cancerous; the decision to perform the extensive  surgery is taken on table.

Diet:

You will be allowed to have sips of water followed by light diet  from the next day

You will be able to start walking from the next day. Stitch removal is done after a week . And total recovery time is 6 to 10 weeks.

  • Anesthesia related complications
  • Bleeding
  • Pain
  • Injury to the surrounding structures.

Laparoscopy is the gold standard for the ovarian cyst surgery due to its minimally invasive benefit.

Anesthesia: General anesthesia

Incision: 3 to 4 tiny incisions or holes on the abdomen.

After you are anesthetized, your surgeon will inflate the abdomen with carbon dioxide gas with the help of a special needle to see the organs clearly. And then through tiny incision laparoscope will be introduced. A specially designed endobag will be introduced through the other incision and either the cyst is enucleated intact or after controlled spillage of the contents inside the endobag and removed through the side incision..

Sometimes it is not possible to enucleate the ovarian cyst completely as in case of a chocolate cyst; where simple drainage and cauterizing the base of the cyst is done .

Diet after laparoscopic surgery for ovarian cyst  

You will be allowed to have sips of water followed by light diet after 2 hours of surgery

Mobilisation after laparoscopic surgery for ovarian cyst 

You will be advised to walk in the room  4 to 6 hours after the surgery.Early mobilization is the main benefit of laparoscopy.It ensures faster recovery .

You may be discharged on the same day.  You will be advised to perform all routine light activities once you are discharged. You will be asked to avoid heavy and strenuous activities for 2 weeks after the surgery.

  • Early discharge to home
  • Cosmetically better appearance as laparoscopy involves putting tiny incisions
  • Less pain
  • Early mobilisation
  • Anesthesia related compliations
  • Bleeding
  • Injury to the surrounding structures.
  • Infection
  • Recurrence of ovarian cyst
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