Ovarian Cystectomy: A Detailed Guide
An ovarian cystectomy is a surgical procedure that removes ovarian cysts, which are fluid-filled sacs that develop on the ovaries. Ovarian cysts are common and usually harmless, but sometimes they can cause pain, discomfort, or complications. Let’s explore what an ovarian cystectomy is, why it is done, how it is performed, and what to expect after the surgery.
What are Ovarian Cysts and What Causes Them?
Ovarian cysts are sacs or pouches that form on the ovaries, which are the female reproductive organs that produce eggs and hormones. There are two main types of ovarian cysts:
- Functional cysts: These are the most common type of ovarian cysts. They form as a result of the normal menstrual cycle, when an egg is released from a follicle (a small sac) on the ovary. Sometimes, the follicle does not rupture and release the egg, or it does not shrink after releasing the egg. This causes the follicle to grow larger and fill with fluid, forming a cyst. Functional cysts usually go away on their own within a few months.
- Non Functional cysts: These are less common and can be caused by various conditions, such as endometriosis, polycystic ovary syndrome (PCOS), pelvic inflammatory disease (PID), or ovarian cancer. Non Functional cysts do not disappear on their own and may require treatment.
Some of the factors that can increase the risk of developing ovarian cysts include:
- Hormonal imbalances or disorders
- Ovulation-inducing drugs
- Pregnancy
- Previous ovarian surgery
- Family history of ovarian cysts or cancer
What are the Symptoms of Ovarian Cysts?
Most ovarian cysts do not cause any symptoms and are discovered during routine pelvic exams or imaging tests. However, some ovarian cysts can cause symptoms such as:
- Pelvic pain or pressure that may come and go or be constant
- Bloating or fullness in the abdomen
- Changes in menstrual periods, such as irregularity, heaviness, or spotting
- Difficulty getting pregnant
- Pain during sexual intercourse
- Urinary or bowel problems
In rare cases, ovarian cysts can cause serious complications, such as:
- Ovarian torsion: This occurs when a large or twisted cyst causes the ovary to twist around its blood supply, cutting off the blood flow and causing severe pain, nausea, vomiting, and fever. This is a medical emergency that requires immediate surgery to untwist the ovary and save it from damage.
- Ovarian rupture: This occurs when a cyst bursts open and spills its contents into the abdominal cavity, causing sudden and sharp pain, bleeding, infection, or shock. This can also be a medical emergency that requires prompt treatment with antibiotics and surgery.
Why is an Ovarian Cystectomy Done?
An ovarian cystectomy is done to remove ovarian cysts that are causing symptoms or complications, or that are suspected to be cancerous. The main goals of an ovarian cystectomy are to:
- Relieve pain and discomfort
- Preserve fertility and ovarian function
- Prevent complications such as torsion or rupture
- Diagnose or treat ovarian cancer
Your healthcare provider may recommend an ovarian cystectomy if you have:
- A large cyst (typically more than 2.5 to 3 inches in diameter)
- A persistent or growing cyst that does not go away after several menstrual cycles
- A complex or solid cyst that has an irregular shape or contains blood or tissue
- A history of ovarian cancer or a family history of breast or ovarian cancer
- A desire to get pregnant
How is an Ovarian Cystectomy Performed?
An ovarian cystectomy can be performed in two ways:
- Laparoscopic ovarian cystectomy: This is a minimally invasive procedure that uses small incisions and a camera (laparoscope) to remove the cyst. Your surgeon will make one small incision near your belly button and insert the laparoscope, which has a light and a lens that allows them to see your ovaries and other pelvic organs on a monitor. They will make two other small incisions on your lower abdomen and insert surgical instruments through them. They will then cut out the cyst from the ovary and remove it through one of the incisions. They may also take a sample of tissue (biopsy) from the ovary or the cyst for further testing. They will then close the incisions with stitches or glue.
- Open ovarian cystectomy (laparotomy): This is a more invasive procedure that uses one large incision to remove the cyst. Your surgeon will make an incision across your lower abdomen, either horizontally (bikini cut) or vertically (midline cut). They will then move aside your abdominal muscles and tissues to expose your ovaries and other pelvic organs. They will then cut out the cyst from the ovary and remove it. They may also take a biopsy from the ovary or the cyst for further testing. They will then close the incision with stitches or staples.
Both procedures are done under general anaesthesia, which means you will be asleep and not feel any pain. The type of procedure you will have depends on several factors, such as the size, location, and nature of the cyst, your medical history, your preference, and your surgeon's expertise. Laparoscopic ovarian cystectomy is usually preferred because it has less risks, less pain, and faster recovery than open ovarian cystectomy. However, open ovarian cystectomy may be necessary if the cyst is very large, complex, or cancerous, or if there are other complications.
What are the Risks and Complications of an Ovarian Cystectomy?
An ovarian cystectomy is generally a safe and effective procedure, but like any surgery, it has some risks and possible complications. These include:
- Bleeding
- Infection
- Damage to nearby organs, such as the bladder, bowel, or blood vessels
- Adhesions (scar tissue) that can cause pain or infertility
- Anaesthesia-related problems, such as allergic reactions or breathing difficulties
- Recurrence of ovarian cysts
- Loss of ovarian function or fertility (rare)
What is the Recovery Process After an Ovarian Cystectomy?
The recovery process after an ovarian cystectomy depends on the type of procedure you had and your overall health. In general, you can expect to:
- Stay in the hospital for a few hours (laparoscopic) or a few days (open) after the surgery
- Have some pain, swelling, bruising, or bleeding around the incision site
- Take painkillers and antibiotics as prescribed by your doctor
- Avoid strenuous activities, lifting heavy objects, driving, or sexual intercourse for a few weeks
- Resume your normal activities and diet gradually as you feel comfortable
- Follow up with your doctor for wound care, stitches or staples removal, and biopsy results
Your doctor will give you specific instructions on how to care for yourself after the surgery and when to return for a checkup. You should contact your doctor if you have:
- Signs of infection, such as fever, chills, redness, pus, or foul-smelling discharge from the incision site
- Severe or worsening pain that is not relieved by painkillers
- Heavy bleeding or clots from your vagina
- Nausea, vomiting, or difficulty urinating or having a bowel movement
- Shortness of breath, chest pain, or irregular heartbeat
How Does an Ovarian Cystectomy Affect Fertility and Pregnancy?
An ovarian cystectomy can affect your fertility and pregnancy depending on how much of your ovary was removed and whether you have any other conditions that affect your reproductive health. In most cases, an ovarian cystectomy does not affect your fertility and pregnancy if:
- Only the cyst was removed and your ovary was preserved
- You have another healthy ovary that can produce eggs and hormones
- You do not have any other problems with your uterus, fallopian tubes, or hormones
However, an ovarian cystectomy can affect your fertility and pregnancy if:
- Part or all of your ovary was removed
- You have only one ovary left or both ovaries were removed
- You have scar tissue or adhesions that block your fallopian tubes or interfere with implantation
- You have other conditions that affect your ovulation or menstrual cycle
If you are planning to get pregnant after an ovarian cystectomy, you should talk to your doctor about your chances of conceiving naturally or with assisted reproductive technologies (ART), such as in vitro fertilisation (IVF). You should also wait until you are fully healed from the surgery before trying to conceive.
Sources
[1] Debbo Africa: https://debbo.africa
[2] Cleveland Clinic. (2023). Ovarian Cystectomy: Purpose, Procedure,
Risks & Recovery: https://my.clevelandclinic.org/health/treatments/24427-ovarian-cystectomy
[3] Mayo Clinic. (2023). Ovarian cysts - Symptoms and causes. Retrieved from https://www.mayoclinic.org/diseases-conditions/ovarian-cysts/symptoms-causes/syc-20353405
[4] Verywell Health. (2023). Ovarian Cyst Surgery: Everything You Need to Know. Retrieved from https://www.verywellhealth.com/ovarian-cyst-surgery-5197511