Ovarian cyst when surgery is necessary. Ovarian cyst: dangerous and normal sizes for surgery. Preparation for the operation

Cystectomy - removal of an ovarian cyst

Access - through 3 mini-punctures

Operation time - 60 - 120 min

Time of hospital stay - 1 day

Cost of the operation: from 30,000 rubles. *

(excluding the cost of anesthesia and hospital stay)

Before the operation of laparoscopy of ovarian cysts, anesthesia is performed. In our Center, this procedure is performed by highly qualified anesthesiologists, using individually selected dosages of safe drugs. We perform removal of an ovarian cyst under general endotracheal anesthesia.

Depending on the indications, the doctor performs the operation through laparotomy (through an incision in the abdominal wall) or laparoscopic (through three punctures in the lower abdomen) access. In the latter case, carbon dioxide is injected into the abdominal cavity, providing the surgeon with a better view of the operated area, and the operation is performed using a video camera and endoscopic instruments. The doctor monitors the progress of laparoscopic surgery to remove an ovarian cyst using images on the monitor.

The cyst is removed by peeling it out of the capsule. If the tumor is large, the gynecologist-surgeon will first remove its contents with an aspiration needle to reduce the risk of rupture of the cyst capsular membrane. After removing the tumor, the doctor coagulates the bleeding vessels and places sutures at the incision sites. The removed tissue is sent for histological analysis to the Center's laboratory. The patient is transferred to a comfortable room in our hospital.

Other operations for ovarian cysts

If the clinical situation allows, the Center’s surgeons strive to perform laparoscopic operations, as they can reduce tissue trauma and significantly shorten the recovery period. In addition, it is important for surgeons to preserve the woman’s organs and their functions. However, if this is not possible (significant volume of the cyst, risk of developing a cancerous tumor, etc.), our doctors also perform other operations:

Ovarian resection. The intervention involves removal of the cyst and excision of ovarian tissue to prevent relapse.
Ovariectomy. The cyst is removed along with the ovary on which it formed. The operation is performed for large tumors or inflammatory processes in the ovary.
Adnexectomy. During the intervention, the cyst is removed along with the uterine appendages: the ovary and fallopian tubes. Our doctors perform both unilateral and bilateral (according to strict indications) adnexectomy.

The Assuta Clinic is the oldest medical institution in Israel, which since its founding in 1934 has played a huge role in the development of the country's healthcare system. For many decades, the center has faithfully followed the principles laid down by its creators: quality patient care and scientifically proven effective treatment. Assuta is the first Israeli clinic to receive a JCI (International healthcare accreditation) certificate in 2011 confirming compliance with international standards of medical care.a

Today, the clinic is considered an innovative medical center in the Middle East, where patients are guaranteed to receive the most modern treatment. The priority area of activity is surgery, which is most developed in Assuta. Dozens of prominent specialists are involved in women's reproductive health, and this task is mainly solved by doctors in the gynecological department.

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Gynecological Department of Assuta Clinic

A large number of women, in search of a reliable and trusted specialist, prefer Israeli doctors - and they are not mistaken in their choice. Every year, hundreds of patients turn to Israeli gynecologists who are desperate to find a qualified specialist in their homeland.

The gynecological department of the Assuta clinic is equipped with the latest medical technology. Diagnosis and treatment of female diseases is carried out by talented doctors with extensive practical experience. Assuta gynecologists are true masters of their craft, known not only in Israel, but throughout the world.

Ovarian cysts are a common problem in women of childbearing age. This disease is based on both physiological and pathological factors. A competent assessment of the cause that led to the formation of the cyst is the key to effective treatment.

As a rule, an ovarian cyst does not manifest itself in any way and is discovered during an examination for another reason. However, some women may experience various symptoms, such as:

Discomfort in the lower abdomen.
Drawing pain.
Sensation of a round swelling under the navel or on the sides of it.
Frequent urination.
Infertility.

The diagnosis of ovarian cyst is established on the basis of ultrasound examination of the pelvic organs (both traditional ultrasound and transvaginal). This research method allows us to establish the presence of a neoplasm, but does not say anything about its structure, which is directly related to its benign or malignant nature. To do this, it is necessary to conduct a histological examination of a fragment of the organ. The easiest way to do this is after surgery.

Further therapeutic tactics depend on the structure and size of the cyst. For small formations caused by malfunctions of the endocrine system, conservative treatment is indicated, including in the form of hormone replacement therapy. But if the process develops too quickly, raising suspicions about the malignant nature of the growth, and is accompanied by unpleasant symptoms, surgical intervention is required.

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Surgery to remove an ovarian cyst

For this disease, there are two types of surgical access - open (through an incision on the anterior abdominal wall) and laparoscopic. Each of them has its own advantages and disadvantages. Abdominal surgery to remove a cyst on the ovary is optimal for large tumors and complex anatomy of the pelvic organs. It is also chosen for the malignant nature of the process with germination into surrounding tissues and metastases into regional lymph nodes, since open access allows the surgeon to carry out manipulations freely and without any restrictions.

Preparing for surgery to remove an ovarian cyst

Before surgery, each patient undergoes a thorough general clinical examination to identify possible contraindications. The minimum set of studies includes:

General blood test (assessment of hemoglobin level, early detection of infectious and inflammatory diseases).
Biochemical blood test (assessment of the functions of the liver, kidneys and other internal organs).
Coagulogram (determination of the functions of the blood coagulation and anticoagulation systems).
Determination of blood group and Rh factor (in case of need for blood transfusion).
Urinalysis (exclusion of renal pathology).
Electrocardiography.
Magnetic resonance imaging (MRI) of the pelvic organs.

The patient must be consulted by a general practitioner, and in the case of extragenital pathology, by other specialists. This is necessary for the timely identification of contraindications to surgery, since if they are present, surgery can be extremely dangerous.

On the day before surgery, the patient should drink a special laxative solution to cleanse the intestines. To further empty the rectum, a cleansing enema is performed several hours before surgery.

Contraindications for surgery

There are a number of contraindications to surgical intervention for ovarian cysts. Some of them are relative, which requires the surgeon to be extremely careful, and some are absolute, that is, they categorically prohibit the operation.

It is prohibited to do this in the following cases:

Chronic heart failure in the stage of decompensation (the heart will not be able to withstand such a load).
Decompensated diabetes mellitus (high risk of suture dehiscence and postoperative wound suppuration with subsequent development of sepsis).
Blood clotting disorders - thrombocytopenia, hemophilia and other coagulopathies (this is an immediate threat of fatal bleeding during surgery).
Acute infectious diseases.
Acute myocardial infarction.
Stroke.
Shock, which in gynecological practice is often caused by massive bleeding from the genital tract.

If these contraindications are present, surgery should be postponed until the patient is cured of these diseases or stabilizes her condition. For this purpose, you can contact the specialists of our clinic.

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Progress of the operation

Immediately before surgery, the patient is given premedication - the administration of medications that will relieve anxiety and anxiety, as well as prevent the development of adverse events during and after the operation.

The surgery is performed under general anesthesia, which means without any sensation. The effect of anesthesia can be compared to a state of sleep. The awakening will occur in the intensive care ward, and the patient will not remember anything that happened to her during the operation.

The surgical procedure is as follows:

First, the surgeon will treat the surgical field - the lower abdomen - with an antiseptic solution to prevent pathogenic bacteria from entering the abdominal cavity.
Then, layer by layer, step by step, the skin, subcutaneous fat, muscles with fascia and peritoneum are dissected. More often, a lower median laparotomy is performed - a longitudinal incision along the midline running from the navel to the pubis. Less commonly, a transverse Pfannenstiel incision is used above the pubic region, where the natural fold of the abdomen is located (the same incision is made, for example, during a caesarean section).
After spreading the edges of the wound, the surgeon examines the pelvic organs for the presence or absence of pathological processes that might not be visible during ultrasound examination.
The main stage of the operation is removal of the ovarian cyst. If the size of the formation is small, ovarian resection is performed - removal of the organ fragment affected by the cyst. If the pathological process is pronounced, and the ovary is almost completely replaced by a cyst, then oophorectomy is indicated - complete removal of the ovary.
The final stage of the operation is layer-by-layer suturing of the wound with the obligatory installation of temporary drainage.

As a rule, surgery lasts no more than 2 hours. However, if a malignant nature of the cyst is suspected, an extended operation may be required, including removal of the fallopian tube on the affected side, as well as regional lymph nodes. The doctor determines surgical tactics in each individual case.

Postoperative period after removal of an ovarian cyst

The postoperative period lasts on average 1-2 weeks. The patient spends the first 2-3 days in the intensive care unit, since at this time there is always a risk of developing early complications, such as:

Internal bleeding.
Seams coming apart.
Suppuration of a postoperative wound.
Pulmonary embolism.

Fortunately, this happens extremely rarely thanks to the use of the most modern equipment and drugs with proven effectiveness.

On the first day, the patient may experience unpleasant sensations such as pain in the area of the surgical wound, discomfort in the throat, and chilling. This is absolutely normal and does not require any special treatment. It is very important after abdominal surgery to remain calm and not make unnecessary movements for at least 1-2 days so that the edges of the wound can heal a little.

Sutures require careful and regular care to prevent inflammation and even suppuration. Every day, the surgeon examines the postoperative wound, and the nurse changes the bandages and treats the wound with antiseptics. These simple steps provide reliable protection against dangerous complications.

After the patient is transferred to the general ward, a rehabilitation period begins. You should gradually increase the load on the abdominal muscles, but in no case overdo it. This is fraught with the development of a postoperative hernia, which will require repeated surgery.

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Frequently asked questions and their answers

How is surgery to remove an ovarian cyst performed?

For ovarian cysts, both abdominal and laparoscopic surgeries are performed. The first ones are done more often for large cystic formations that are suspicious of a malignant neoplasm, the second ones are done to remove small cysts.

Abdominal surgery is performed under general anesthesia in several stages. First, the surgeon provides access to the problem area by making an incision in the lower abdomen. The main second stage is removal of the cyst itself. Depending on its size and malignant potential, ovarian resection (the cyst is “cut off” from it), oophorectomy (removal of the entire ovary), adnexectomy (removal of the ovary along with the fallopian tube) and lymph node dissection (removal of regional lymph nodes) can be performed. At the final stage, the doctor installs a drainage into the abdominal cavity and sutures the surgical wound.

Laparoscopic surgery is also performed under general anesthesia. Several small holes are made on the front wall of the abdomen, through which the necessary instruments are inserted into the body. Gas is then injected into the abdominal cavity to move the internal organs away from each other and provide the surgeon with a larger field of vision. Further actions of the doctor are similar to those during abdominal surgery.

How long does surgery to remove an ovarian cyst take?

As a rule, surgery lasts no more than 2 hours. If complications arise, as well as in the case of a large size of the cyst and suspicion of its malignant nature, the operation can take up to 3-4 hours.

How long do you have to stay in the hospital when you have an ovarian cyst removed?

Preparation takes on average 2-3 days. The postoperative period for open surgery is 1-2 weeks. Thus, the total duration of treatment for ovarian cysts is no more than 2 weeks. These are average figures - the length of stay in the hospital is determined individually in each case.

What are the consequences of removing an ovarian cyst?

On the first day after surgery, the following symptoms are possible, which are completely normal:

Drowsiness, lethargy, chills, which is associated with the residual effect of anesthesia.
Sore throat from the anesthesia tube.
Unpleasant sensations in the area of the postoperative wound.

There is no need to fight drowsiness - if the patient wants to sleep, then it is better for her to rest. The sore throat goes away within a day, but if this does not happen, then you can recommend warm drinks and gargling with antiseptic solutions. When you have a chill, it is enough to cover yourself with a warm blanket or blanket to keep warm.

After the operation, disturbances in the monthly cycle are possible. Menstruation may come the next day, or may not occur for 1-2 months. All this is due to some hormonal changes, but over time the cycle, as a rule, is restored.

For 2-3 days after the operation, you should remain in bed and not make unnecessary movements. If this is not done, then there is a high risk of suture dehiscence and the development of a postoperative hernia.

Is pregnancy possible after removal of an ovarian cyst?

Yes, it's possible. Such an operation should not be regarded as sterilization - this is absolutely not the case. Hundreds of thousands of women were able to give birth to normal children after this surgical intervention.

But you need to keep in mind that pregnancy will not occur immediately. Due to the direct effect on the ovary during surgery, hormonal disruptions may occur for 2-3 months after surgery, which is manifested by irregular menstruation. As soon as the cycle is restored, you can think about planning a pregnancy.

How much does it cost to remove an ovarian cyst in your clinic?

Treatment tactics are determined individually in each individual case, since the disease progresses differently in all women. As a result, the estimated cost of the operation ranges from $7,000 to $14,000.

Hundreds of women entrusted their health to the specialists of the Assuta clinic, and did not regret it. Thanks to numerous positive reviews, we can be proud of the professionalism of our doctors - truly the best gynecologists in Israel.

Ovarian cysts are a common cause of lower abdominal pain and infertility. They come in different origins and structures, but a cyst of any type at a certain stage of its development may require surgical treatment. A modern gentle surgical method is laparoscopy of an ovarian cyst, which allows to shorten the length of hospitalization and speed up the patient’s postoperative recovery.

What is an ovarian cyst

A cyst is a round, hollow formation on the surface of the ovary or in its thickness, resembling a bubble. Its contents and wall structure depend on its origin. Although it is a benign tumor, some types of cysts can degenerate into cancerous cells. This process is called malignancy.

Sometimes a similar formation occurs in ovarian cancer, when, due to central disintegration, an uneven cavity is formed inside the tumor. During examination, women may also be diagnosed with paraovarian cysts. The fallopian tubes take part in their formation, but the ovarian tissue remains unchanged.

Possible types of ovarian cysts:

, which is formed from a follicle that did not rupture during the ovulatory period, streaks of blood are sometimes found in the fluid inside such a cyst;
, which occurs at the site of the ovulated follicle (in the corpus luteum), contains serous fluid and sometimes an admixture of blood from destroyed small vessels;
, which develops when endometrial cells multiply outside the lining of the uterus, undergoes cyclic changes in accordance with the menstrual cycle and contains a dark, thick liquid;
a dermoid cyst (or mature teratoma) may contain germinal tissue or even partially formed formations (teeth, hair), is formed at the site of an egg that has begun to develop independently and is often congenital;
mucinous - is multi-chambered and contains mucus, can grow up to 40 cm in diameter.

Follicular cysts can be multiple, in this case they speak of. In each cycle, the egg does not ovulate; the follicle continues to grow and turns into a cavity under the outer membrane of the ovary. Other types of cysts are usually solitary.

When does pathology require treatment?

Follicular and luteal cysts are hormonal-dependent and can gradually resolve. But if they reach large sizes and do not undergo reverse development, they must be removed. When endometrioid formations are detected, conservative therapy is first prescribed. If it is ineffective and there are large formations, a decision is made on surgery. All other types of cysts require only surgical treatment. In case of infertility, the doctor may recommend removing even small tumors, after which hormonal therapy is most often prescribed.

The purpose of the operation is to completely remove the pathological formation. In women of reproductive age, they try to preserve ovarian tissue as much as possible, performing only resection. And in postmenopause, when sex hormones are practically no longer produced, the entire organ can be removed without consequences for the woman’s health.

The operation is performed using the classical method (through an incision on the anterior abdominal wall) or laparoscopic removal of the ovarian cyst is performed. In both cases, the woman goes to the hospital, most often such hospitalization is planned.

Benefits of laparoscopy

Removal of an ovarian cyst by laparoscopy is a gentle intervention. All manipulations are performed through 3 punctures of the abdominal wall. In this case, the abdominal muscles are not dissected, the thin inner serous lining of the abdominal cavity (peritoneum) is minimally injured, and there is no need to manually move the internal organs away from the surgical site.

All this determines the main advantages of the laparoscopic method over classical surgery:

lower risk of development in the future;
low probability of a postoperative hernia, which may occur due to incompetence of the dissected muscles of the anterior abdominal wall;
small volume of surgical wounds, their rapid healing;
gentle effect on neighboring organs during surgery, which reduces the risk of postoperative intestinal hypotension;
fewer restrictions in the postoperative period, earlier discharge from the hospital;
no deforming postoperative scars; puncture marks can be hidden with underwear.

The laparoscopic treatment method allows a woman to quickly return to normal life, without being embarrassed by her appearance and without worrying about the possible development of long-term consequences after surgery.

Preparation

Before laparoscopic surgery to remove an ovarian cyst, a woman must undergo an examination, which is usually performed on an outpatient basis. It includes a general and biochemical blood test, urine test, blood collection for screening for hepatitis, syphilis and HIV, ultrasound of the pelvic organs, fluorography of the lungs, determination of blood group and Rh factor, and a vaginal smear for purity. In some cases, it may also be necessary to do an ECG, examine the state of the blood coagulation system, determine the hormonal status, and obtain a physician’s opinion on the absence of contraindications to surgery. The scope of research is determined by the doctor based on the overall clinical picture.

Before performing planned laparoscopy of an ovarian cyst, reliable methods of contraception are used. If you suspect pregnancy, you must inform your doctor in advance.

A few days before surgery, you need to exclude cabbage, legumes, carbonated drinks, brown bread and other foods that increase gas formation in the digestive tract from your diet. If you are predisposed to flatulence, the doctor may recommend taking sorbents and carminatives; cleansing the lower intestines is often prescribed. On the eve of the intervention, the last meal should be no later than 18:00, you can drink until 10:00 pm. On the day of the operation, it is forbidden to drink or eat; if you are very thirsty, you can rinse your mouth and moisten your lips with water.

Immediately before laparoscopy, pubic and perineal hair is shaved and a hygienic shower is taken. After this, you should not apply lotions, creams or other care products to the skin of the abdomen.

How is laparoscopy performed?

Laparoscopy for removal of an ovarian cyst is performed under general anesthesia (anesthesia). On the day of the operation, the woman is consulted by a resuscitator to identify possible contraindications and make a final decision on the type of anesthesia. Most often, tracheal intubation is used, which allows you to control breathing and maintain the required depth of immersion in anesthesia. Before this, premedication is carried out, when a sedative with a hypnotic effect is administered intravenously; tranquilizers are usually used for this. Instead of such an injection, you can use mask anesthesia.

The operating table is tilted with the head end down by 30º so that the intestine moves towards the diaphragm and opens access to the ovaries. After processing the surgical field, a puncture is made in the navel, through which the abdominal cavity is filled with carbon dioxide. This allows you to increase the distance between organs and creates space for the necessary manipulations. A laparoscope, a special instrument with a camera and a light source, is inserted into the same hole. It is advanced to the pelvis, where the ovaries are located. Under the control of a video camera, 2 more punctures are made in the lateral sections of the abdomen, closer to the groin, which are necessary for introducing manipulators with instruments.

After a thorough examination of the ovaries and cysts, a decision is made to continue laparoscopy or whether wide access to the abdominal cavity is necessary (which is quite rare). In the latter case, all instruments are removed and the classic operation begins.

During laparoscopy, the doctor can perform enucleation of the cyst, wedge-shaped resection (excision) of a fragment of the ovary with a cyst, or removal of the entire ovary. The extent of surgical intervention is determined by the type of cyst and the condition of the tissues surrounding it. At the end of the operation, a check is made for the absence of bleeding, the instruments are removed, and carbon dioxide is sucked out. External sutures and sterile dressings are applied to the puncture sites.

After removing the endotracheal tube, the anesthesiologist checks the patient’s breathing and her condition, and gives permission to transfer to the ward. In most cases, the patient does not need to be admitted to the intensive care unit, since vital organs are not disrupted and massive blood loss does not occur.

Postoperative period

After laparoscopy, getting out of bed early is recommended. After just a few hours, with stable blood pressure, it is advisable for the woman to sit down, stand up, and carefully move around the ward. A gentle diet is prescribed, including fermented milk products, stewed vegetables and meat, soups, fish, without products with gas-forming properties.

Sutures are treated daily and body temperature is monitored. Discharge is made 3-5 days after surgery, but sometimes already in the evening of the first day. Sutures are removed on an outpatient basis for 7-10 days. Full restoration of working capacity usually occurs by the 14th day, but if the woman is in good condition, the certificate of incapacity for work can be closed earlier.

Possibility of pregnancy

Until the end of the current menstrual cycle, it is advisable to exclude intimate contacts; if this recommendation is not followed, contraception must be used. Pregnancy after laparoscopy of an ovarian cyst can occur in the next cycle. Therefore, you should definitely check with your doctor when you can stop using contraception. With functional cysts (luteal and follicular) and polycystic ovary syndrome, conception is most often allowed after the first menstruation, if the operation and recovery period were without complications. But after removal of endometrioid cysts, a stage of drug treatment often follows.

Possible complications

The most common complication after laparoscopy of an ovarian cyst is pain. Moreover, unpleasant sensations are noted not in the area of the operation or punctures, but in the area of the right side and right shoulder. This is due to the accumulation of carbon dioxide residues near the liver, which irritates the phrenic nerve. Muscle pain and mild swelling of the lower extremities may also be noted.

In the first days after laparoscopy, subcutaneous emphysema may be observed, that is, an accumulation of gas in the upper layers of fatty tissue. This is a consequence of a violation of the surgical technique and does not pose any health hazard. Emphysema resolves on its own.

In the long-term postoperative period, adhesive disease occasionally develops, although the risk of its occurrence after laparoscopy is much lower than after classical surgery.

When laparoscopy is not performed

Despite the woman’s wishes, the doctor may refuse to perform laparoscopic surgery in the following cases:

severe obesity (grade 3-4);
detection of stroke or myocardial infarction, decompensation of existing chronic diseases;
severe disturbances of hemostasis due to blood coagulation pathology;
abdominal surgery less than 6 months ago;
suspicion of a malignant tumor (cyst) of the ovary;
diffuse peritonitis or severe hematoperitoneum (accumulation of blood and abdominal cavity);
the woman’s state of shock, increasing severe blood loss;
pronounced changes in the anterior abdominal wall with fistulas or purulent skin lesions.

Removal of an ovarian cyst laparoscopically is a modern and gentle method of surgical intervention. But the operation should take place after a preliminary thorough examination of the woman in the absence of contraindications to it. It must be remembered that some cysts can form again if predisposing factors are not eliminated. Therefore, in case of functional cysts, a dynamic study of hormonal status and correction of identified disorders are required.

Ovarian cyst is one of the most common diagnoses in gynecology. An ovarian cyst is a benign neoplasm that does not always require surgical intervention.

Varieties

The cyst can have a different character. There are follicular, endometrioid, dermoid, cystadenoma, and corpus luteum cyst.

Follicular. A follicular cyst is characterized by the fact that its size depends on the time of the cycle. Most often it disappears after the onset of menstruation. Some hormonal imbalances can cause it to remain and grow in size. A follicular ovarian cyst appears during ovulation.

As it increases in size, it can rupture - this is called ovarian apoplexy. Typically, apoplexy occurs during follicle rupture, or during ovulation.

The question of whether an ovarian cyst needs to be removed is decided after diagnosis. If there are several days left until the next period, the doctor usually decides to wait for it and give it a few days for the cyst to resolve. If this does not happen, a decision is made to delete. Such cysts can reach 3 cm in size. They are usually treated with medication. The phenomenon of polycystic disease is also possible, when 3-5 small cysts of small size are formed.

Corpus luteum cyst. This ovarian cyst is formed from the corpus luteum. When the follicle ruptures during ovulation, the corpus luteum is formed to produce hormones. When menstruation occurs, the corpus luteum disappears.

In pathological cases, it may not disappear, but fill with fluid, which is called a cyst. The danger of this formation is that symptoms appear only if it has already increased and puts pressure on neighboring organs. Dimensions reach 3-5 cm.

Dermoid. This ovarian cyst most often occurs in women of reproductive age. It belongs to benign neoplasms, and connective tissues of different nature can be found inside.

A complication can occur if she has a thin pedicle causing ovarian torsion. In this case, surgery to remove the ovarian cyst is required. Sizes from 1 to 3 cm.

Endometrioid. This disease is a consequence of endometriosis. Foci of inflammation, common not only on the reproductive organs, but also on the outer walls of the intestine, are accompanied by prolonged pain and can cause a tumor measuring three to four centimeters. In this case, surgery is performed to remove the cyst to prevent further spread of endometriosis.

Symptoms

The symptoms of a cyst depend on its origin. Some do not manifest themselves for a long time, and pain appears only after the tumor grows in size.

Usually a woman feels that the ovary hurts, some twitching in the ovary is possible. The disease is often accompanied by menstrual irregularities.

With apoplexy or torsion of the leg, a sharp pain is felt in the lower abdomen, spreading to the entire pelvic area. At the same time, heat often rises to the patient’s face.

Some neoplasms can cause bleeding in the middle of the cycle, or cause the existing duration of menstruation to drag on for several days longer. At the first such symptoms, you should immediately seek help.

With such discharge, the blood takes on a brown tint, and blood clots or white streaks are possible. If in the middle of the cycle you experience spotting brown discharge for 3-4 days, it is advisable to seek help as early as possible.

Causes

The reasons for the development of cysts are systematic irregularities in the menstrual cycle, the onset of the first menstruation very early - at 11 years of age or earlier. It is possible that cysts have already been removed before or that treatment was carried out incorrectly after removal of an ovarian cyst.

The presence of problems with endocrine organs, as well as the prevention or treatment of infertility, also causes the formation of cysts. Other reasons include poor diet, bad habits, and promiscuity.

Diagnostics by ultrasound

Before the operation, mandatory monitoring of the condition of the ovary at the moment is carried out. Ultrasound can be performed through the abdominal wall or transvaginally. The first study is carried out with a full bladder, the second does not require filling the bladder, therefore, when prescribing an ultrasound, you need to check with your doctor about the recommended type of study.

Diagnostics by laparoscope

Laparoscopy is not only a method of surgical intervention, but also a fairly informative diagnostic method. Laparoscopic examination allows you to obtain the most complete information about the condition of the abdominal organs, while it is possible to simultaneously cure the detected disease.

Laboratory research

Laboratory testing includes a hormonal blood test to identify possible hormonal imbalances in a woman. A general urine test and a blood test for tumor markers are also taken. There are only 3 main blood tests: tumor marker, biochemistry and general.

Laboratory tests simultaneously provide information about the functioning of the liver and kidneys, allowing timely identification of possible complications and implementation of appropriate therapy.

Culdocentesis

The method involves performing a puncture to determine the contents of the pouch of Douglas. Usually, when a cyst ruptures, its contents flow into the pouch of Douglas, so puncture allows you to accurately determine its contents and adjust further treatment tactics.

When surgery is not needed

Sometimes the attending physician may postpone surgery if the cyst does not increase in size and does not interfere with the functioning of neighboring organs. A cyst can be treated with hormonal drugs and drugs for resolving the cyst, if its nature and nature are accurately determined.

Some cysts go away on their own within a cycle or two, requiring only accompanying therapy. If this does not happen, subsequent removal of the ovarian cyst is prescribed.

Surgical removal methods

An ovarian cyst is surgically removed in two ways: surgically and laparoscopically. In general, laparoscopy is also a type of surgical intervention, but in this case, surgical intervention means traditional intervention using a fairly large incision with a scalpel.

Laparoscopy is a more modern and gentle method of removal; more and more hospitals are trying to use it. However, not all medical institutions can afford special equipment, so sometimes removal is carried out through traditional surgery. Sometimes, for one reason or another, a doctor’s recommendations may still be directed towards traditional intervention.

Removal laparoscopically

Laparoscopy, the purpose of which is diagnosis and simultaneous treatment, is performed under general anesthesia. Laparoscopy requires special equipment and skill from the surgeon.

First, the abdominal cavity is filled with gas, usually carbon dioxide. To carry out the entire operation, four incisions of no more than two centimeters are made. Through one, a gas supply is introduced - the gas filling the abdominal cavity will lift the wall and make the organs more accessible for examination and removal of the ovarian cyst.

Through the second puncture, a video camera is inserted to examine the condition of the organs - the image from the camera is fed to a monitor near the operating chair.

For surgical actions, instruments are inserted into the remaining two punctures. The instrument is not inserted directly but requires a metal tube to prevent the instruments from touching the skin.

After the surgeon detects the cyst, its surface is punctured and emptied. Once the contents of the cyst are released, it can be easily removed.

Preparation

Since the operation is performed under general anesthesia, before excision of the cyst, preparation is required - exactly the same as before surgery.

To do this, not only a laboratory test is carried out, but also an additional blood clotting test.
An ECG will be required.
Before starting the procedure, you should not eat anything for eight hours.

After operation

Recommendations in the postoperative period will depend on how the patient underwent the operation and how easy it was. Typically, the postoperative period is much easier than if the operation was performed using the traditional surgical method.

The ovary should practically not hurt after removal of the cyst. The wounds themselves do not hurt too much, since they are quite small. Recovery from ovarian cyst removal involves taking pain medications three times a day, as well as antibiotics to prevent infection.

The doctor will prescribe antibiotics and painkillers independently. They will depend on whether the patient is allowed to use antibiotics, and whether this threatens dysbacteriosis in a particular case.

By the evening in the postoperative period, the patient can get up and move independently. Such a movement may even be specifically recommended so that the abdominal muscles do not lose the habit of working independently.

The dressing is performed within a week. It involves changing the bandage and treating the wound with an antiseptic. A bleeding suture must be examined by a doctor. The question of what you can eat and how best to behave for a speedy recovery should still be discussed with your doctor.

Benefits of laparoscopy

Among the greatest advantages of laparoscopy is less trauma for the female body. During laparoscopy, the incisions are made very small and do not require strong restorative forces from the body, as with a standard incision.

It is possible to treat a cyst in this way more effectively, since the body will direct all its forces to healing the scar, and not to healing skin wounds. The postoperative period is significantly reduced, and the number of consequences after removal of an ovarian cyst is noticeably less. From a cosmetic point of view, this method is also more acceptable.

aMain indications for removal surgery

1. The possibility of an oncological process.

2. The cyst does not decrease in size during 3 months of observation, and also does not disappear with hormonal treatment and anti-inflammatory therapy.

3. The neoplasm appeared after menopause.

4. Hemorrhages into the cyst.

5. Rupture of the cyst wall.

6. “Twisting” of the cyst pedicle.

7. Purulent processes that began in the cyst cavity.

We conduct a thorough diagnosis to decide on treatment for ovarian cysts

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Malignant tumor or ovarian cyst?

The doctor thinks about removing even a small cyst no larger than 10 mm in size if research reveals signs that speak in favor of an oncological process. A cancerous tumor is characterized by large wall seals and pathological blood flow. However, errors during ultrasound examination cannot be ruled out. For example, if the cyst cavity is filled with blood, the echographic image will correspond to a tumor.

Therefore, based only on the ultrasound conclusion, it is not always possible to say exactly what we had to deal with - a tumor or a cyst. In such doubtful situations, the patient needs to donate blood to determine the level of the tumor marker CA - 125. Its increase indicates an oncological process, but sometimes it can increase with adnexitis or endometriosis.

If the tumor marker level is within normal limits, and the ultrasound picture is questionable, the gynecologist observes the cyst for 2 to 3 months. Usually, after this period, functional cysts disappear on their own.

When the cyst becomes larger than 1 cm, or the tumor marker level increases, the doctor refers the patient to surgery. This eliminates the possibility of further complications if the tumor turns out to be a malignant tumor.

After the operation, it is possible to accurately establish its nature by examining the cellular structure under a microscope. If suspicions about a tumor are confirmed, the specialist will prescribe additional studies and specific treatment to avoid relapse.

Complications of cysts requiring surgery

Often surgery is necessary, even if the possibility of a tumor is excluded. When a small cyst is detected, a decision is usually made to begin conservative treatment and wait a couple of months. The gynecologist prescribes treatment depending on the suspected cause of the cyst - a hormonal disorder or an infectious-inflammatory process.

If conservative therapy is ineffective for several months, the cyst is removed surgically. All cysts that formed during menopause must also be surgically removed, since there is a high probability of their degeneration into a malignant tumor.

One of the most common complications is “torsion” of the cyst legs, which is accompanied by impaired blood circulation in it. It occurs due to sudden changes in body position, excessive physical activity, severe straining, or chronic coughing. With partial “torsion,” blood continues to flow into the cyst, but its outflow is difficult, so swelling occurs. This condition may be accompanied by unilateral aching pain in the lower abdomen, since due to the increase in the size of the cyst, the pressure inside the ovary increases.

Complete torsion of the leg is accompanied by a violation of the blood supply to the cyst, so necrotic processes begin in it. The situation is aggravated if the woman had chronic infectious diseases of the reproductive system. Under such conditions, the likelihood of infection of the cyst and the development of purulent inflammation in it increases. In the future, it can cause a life-threatening condition - peritonitis. To prevent this, doctors remove the ovarian cyst if its stem is “twisted”.

Rupture of the cyst wall or hemorrhages into its cavity are also indications for surgical intervention. To diagnose such complications, the doctor makes a puncture under ultrasound guidance and takes part of the fluid from the cyst for analysis. If the contents are hemorrhagic or purulent, the tumor is removed. Complications are often accompanied by a vivid clinical picture: abdominal pain, nausea, vomiting, fever.

Thus, an ovarian cyst must be removed in cases where conservative treatment does not help, doubts arise about the oncological process, as well as in the presence of complications that may pose a threat to the preservation of reproductive function or life. A woman who knows that she has an ovarian cyst should be regularly examined by a gynecologist in order to promptly resort to surgical treatment if complications arise.

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