Abdominal surgery to remove an ovarian cyst. Surgery to remove an ovarian cyst. Recovery after laparotomy of an ovarian cyst

An ovarian cyst is a serious disease that requires surgical intervention in most cases. A cyst is usually understood as a small formation that resembles a vesicle and develops on the surface of an organ.

The ovary can be affected by many cysts at the same time. This situation is called polycystic disease and requires the intervention of surgeons for full treatment.

Article outline

When to remove

Surgery for cystic formation is usually recommended for those women whose cyst tends to grow. Such formations do not disappear on their own after several cycles of menstruation and cause a lot of inconvenience.

OPERATION IS A MANDATORY ELEMENT OF TREATMENT ALSO IN THOSE CASES WHEN THERE ARE REASONS TO SUSPECT CANCER DISEASE. IN THIS CASE, THE OPERATION PROCESSES ACCORDING TO TWO MAIN SCHEMES. IN THE FIRST CASE, THE OVARY IS REMOVED COMPLETELY, AND IN THE SECOND CASE, ONLY THE AFFECTED PART IS REMOVED IN ORDER TO PRESERVE THE FUNCTIONAL TISSUE TO THE MAXIMUM.

Cystic formations are always removed in the following cases:

there is a suspicion of cancer;
pain causes a woman a lot of inconvenience and is permanent;
polycystic disease develops;
there is no regression of cyst development;
the formation ruptured and internal bleeding developed;
an enlarged cyst disrupts blood flow in the ovary;
an overgrown cyst puts pressure on surrounding organs, which leads to disruption of their functioning.

Surgery is performed using two main methods: the doctor chooses between laparotomy and laparoscopy. The choice of type of intervention depends on the individual characteristics of the woman and the course of the disease.

Each type of intervention has its own positive and negative qualities.

Laparotomy

Laparotomy is a surgical intervention in which the surgeon performs all manipulations through an incision in the anterior abdominal wall. This type of operation requires a fairly large incision, but is often preferred if the cyst is too large.

Indications for this type of intervention are as follows:

the cystic formation is large;
the cystic formation is affected by a purulent process;
the cyst affects the deep layers of the ovary, due to which its functional activity is significantly reduced;
the pelvic organs are susceptible to adhesions;
additional neoplasms with oncological characteristics were identified in the uterine appendages.

Laparotomy is a more complex surgical procedure compared to laparoscopy. It is also considered more invasive, since the surgeon performs all manipulations through a fairly large incision.

Despite all the features, laparotomy has a number of significant advantages, which include:

it becomes possible to examine and assess the condition of internal organs and lymph nodes located near the cystic formation, which helps in the timely detection of cancer metastases or in case of cyst rupture;
with the help of laparotomy, it is possible to remove large cystic formations filled with liquid secretion, and there is no fear of the cyst rupturing and its contents entering the abdominal cavity;
Laparotomy helps get rid of ovarian tumors without significant blood loss.

A DOCTOR, CHOOSING LAPAROTOMY AS A SURGICAL INTERVENTION, USUALLY DOES THIS IN COMPLEX CASES WHEN REMOVAL OF THE CYST THROUGH A SMALL INCISION IS PROBLEMATIC.

Preparation for surgery (laparotomy)

Laparotomy does not require particularly serious preparation. All a woman needs is to follow the doctor’s recommendations.

Before the intervention, women are not recommended to drink water or eat food. A ban on this is usually imposed from 19-20 pm on the preoperative day if the intervention is scheduled for the morning.
An additional element of preparation is evening and morning enemas. Their task is to cleanse the intestines of feces.

Progress of the intervention

The surgery is performed on the woman under general anesthesia. The course of laparotomy is basically always the same.

First of all, the skin at the incision site is treated with an antiseptic to prevent bacteria from entering the body. After antiseptic treatment, the first incision is made on the skin.
The incision can be made in two main ways: in the first case, the surgeon runs the scalpel parallel to the bikini line, and in the second case, the incision is made vertically. In a vertical incision, the midline of the abdomen serves as a reference point.

After making an incision and detecting a cystic formation, the surgeon must examine the surrounding tissue. Such an examination helps to identify metastases or other unfavorable changes in the female pelvic area.

Depending on the location of the cyst or cysts, the ovary is either completely removed, or the detected tumor is removed from it. After removal, the surgical wound is sutured using a cosmetic suture, which leaves virtually no traces if the healing processes proceed without complications.

The removed tissues are sent to a histology laboratory. There, the origin of the neoplasm is confirmed, and signs of malignant tissue degeneration, if any, are detected. Histology is an important element of diagnosis; it allows you not to miss oncology.

Contraindications

Laparotomy is an invasive intervention that has a number of serious contraindications that impose restrictions on its use. For example, intervention is not carried out in the following cases:

the woman has chronic diseases of the respiratory or cardiovascular system in the acute stage;
the woman suffers from an active infectious process (in this case, the infection is first treated, and then surgery is performed);
the patient has hemophilia or other diseases that interfere with blood clotting processes;
the patient suffers from frequent episodes of high blood pressure;
The woman was previously diagnosed with diabetes of any type.

It is important to remember that laparotomy is an abdominal operation that requires a set of mandatory tests that help assess the woman’s health status and whether she will tolerate the intervention. The doctor has the right to refuse intervention if he does not have accurate data on the woman’s health condition.

Possible complications

Laparotomy is a serious intervention associated with the risk of complications. Doctors usually give a number of recommendations that help minimize risks, but still no one is immune from them. Possible complications include the following conditions:

development of active adhesions in the abdominal cavity;
the appearance of painful sensations in the suture area, which are not so easy to get rid of, even when the wound has already healed;
infectious lesion of a postoperative suture, which requires careful medical care of the wound to prevent purulent complications and sepsis;
an unsuccessful operation during which the intestines or other nearby organs were injured.

Unfortunately, there is no 100% insurance against complications. Careful selection of the operating surgeon helps to significantly reduce risks. Compliance with all medical recommendations in the preoperative and postoperative periods also plays an important role.

Although laparotomy is an abdominal operation, it is rarely associated with a long recovery period unless it is accompanied by complications. So, for example, after the intervention, a woman will have to stay in the clinic for a maximum of 4 days, and only if any difficulties arose during the operation. If the operation went without problems, the woman will be discharged home on the second day.

It is important to remember that full recovery will not occur earlier than in 4-6 weeks (the specific period depends on individual characteristics). Until this happens, the woman will have to follow a number of rules that will prevent the development of complications.
If in the first days after the intervention a woman experiences pain in the area of the postoperative wound or abdominal discomfort, doctors will select painkillers for her. Thanks to the use of medications, unpleasant phenomena can be stopped quickly and easily.

After discharge from the hospital, the woman will have to limit her physical activity for a while. This is necessary so that the seam on the abdomen does not come apart and the wound does not open again. She also needs to remember that for at least a month after the intervention, a complete ban on alcohol consumption is imposed.

Laparotomy is generally well tolerated by patients. During the operation, women of childbearing age are trying to preserve tissues that have functional activity as much as possible so that the patient does not lose fertility and can conceive and give birth to a child.

If the intervention is carried out for a postmenopausal woman, then the ovary affected by the cyst is basically completely removed. This is done to prevent relapses and prevent the degeneration of a benign neoplasm into a malignant one.

What is an ovarian cyst and does it need to be removed?

Laparoscopy

Open abdominal operations such as laparotomy are always traumatic for the human body. Today, they are gradually being replaced by laparoscopic interventions, which have a lower level of trauma.

Laparoscopy is an invasive surgical procedure performed through three small incisions using surgical equipment and a special video camera.. Due to the small size of the incisions and minimal contact between the surgeon and the patient’s insides, laparoscopy is considered less invasive and more preferable than laparotomy.

Indications for laparoscopy when an ovarian cyst is detected are the following conditions:

the cyst is small in size;
the cystic neoplasm is not susceptible to pyogenic lesions;
the cyst is located on the surface of the ovary and has not yet penetrated into its deep layers, has not provoked a violation of the structural integrity and pathological changes in functions;
the cyst is single or the ovary is affected by many small cysts (polycystic).

Features of surgery

Compared with laparotomy, surgical intervention such as laparoscopy has a number of significant advantages. These include:

body tissues are less injured, since although there are three incisions, they are very small;
after laparoscopy, adhesions in the abdominal cavity develop less frequently, since contact with the external environment and instruments is minimal, and the pressure on the organs is much less than during laparotomy;
the postoperative period is associated with fewer restrictions, and also passes much faster, the body recovers in a shorter time;
with laparoscopy, various concomitant infectious complications develop much less frequently, since the entrance gate for infection is smaller in size;
suture dehiscence during laparoscopy is much less common than during laparotomy, even if the woman endures physical activity;
postoperative sutures are very small and do not pose many problems in care.

Laparoscopy today is a more preferable method of intervention compared to laparotomy, since it is associated with a lower risk of complications. Laparoscopy is mainly used to remove small tumors on the ovaries, but in some cases the doctor also uses it during more serious interventions.

Preparing for surgery

As with laparotomy, preparation for surgery begins with tests. Despite the less invasiveness of laparoscopy, it remains an invasive operation, which means it requires the collection of a full set of tests.

Before surgery, doctors conduct an additional assessment of the condition of the pelvic organs. This is necessary in order to identify in advance other pathological processes that may affect the course of the operation. Also, during an additional examination, they try to preliminarily detect adhesive processes in which surgery is not performed.

AS IN THE CASE OF LAPAROTOMY, FOOD AND WATER EATING STOP AT 7-8 PM THE DAY ON THE EVE OF THE OPERATION. AT LEAST CASES, THE LAST TIME YOU CAN HAVE A DRINK IS AT 10 PM.

It is mandatory to perform enemas in the evening and morning before the operation. In some cases, doctors may also recommend the use of laxatives before the procedure.
A consultation with an anesthesiologist before surgery is mandatory. This is necessary for the specialist to make assumptions about the body’s possible reaction to anesthesia and be able to select a medicine that will not cause problems.

Progress of the intervention

The intervention takes place under general anesthesia. The operation itself begins after the patient falls asleep.

First of all, doctors treat the surgical field with antiseptic solutions.

After treating the skin, gas is injected into the abdominal cavity using a special device. The gas in the abdominal cavity helps to slightly separate the organs from each other and makes it much easier for the surgeon to navigate and find the desired organ.
After introducing gas into the abdominal cavity, the surgeon makes several small incisions through which the necessary instruments are inserted into the patient’s pelvis. Interestingly, the surgeon sees the patient’s organs and tissues from the inside using a video camera, which is not used during open operations.
Based on data from the monitor screen transmitted by a camera inserted along with other instruments, the surgeon finds the cyst and removes it. During laparoscopy, healthy organs and tissues are not affected; only the cyst itself is removed.

When the removal is completed, the instruments are removed, and the gas is removed from the patient’s abdominal cavity using a special device. Cosmetic sutures are applied to postoperative wounds and covered with a sterile bandage.

In some cases, the doctor leaves a special silicone tube that provides drainage, for example, of purulent contents. In this case, the tube is removed later, when all excess has been removed from the wound. The patient is warned about the presence of the tube after the intervention.

How to perform laparoscopy - video

Contraindications

Laparoscopy today is one of the safest operations that exist. But, despite its safety, the intervention still has a number of serious contraindications, which are in many ways similar to the indications for laparotomy. These include:

active infectious diseases or chronic infections in the acute stage;
chronic or acute diseases affecting the upper respiratory tract or cardiovascular system;
the presence of a large number of adhesions in the abdominal cavity;
the presence of a hernial protrusion in the midline of the abdomen; pathological changes in the blood clotting system;
malignant nature of the tumor;
excessively large volumes of cystic neoplasm that cannot be removed using laporoscopy.

Possible complications

The likelihood of developing complications after surgery to remove an ovarian cyst using laparoscopy is very low. About 2 out of 100 women experience mild complications.

Mild complications generally include temporary attacks of nausea and vomiting, as well as mild wound infection. The infection is usually accompanied by short-term weakness and fever.

In some cases, it can be difficult to stop bleeding from surgical scars. This complication mainly develops if the patient had problems with blood clotting.

THERE IS A LESS THAN 1% CHANCE THAT MORE SERIOUS COMPLICATIONS WILL DEVELOP, WHICH ARE SOLELY RELATED TO THE PROFESSIONALITY OF THE SURGEON. SO, FOR EXAMPLE, DURING AN INTERVENTION THERE IS A RISK OF DAMAGE TO HEALTHY ORGANS AND TISSUE, BUT IT IS NOT VERY HIGH IF THE DOCTOR IS A PROFESSIONAL IN HIS CASE.

Careful selection of a specialist, as well as careful implementation of all recommendations, will help in the fight against postoperative complications. Laparoscopy is an intervention in which much depends on the skills of the operating doctor and his professionalism.

Recovery period after surgery

After laparoscopy, the patient is left in the hospital under medical supervision for another day. This is necessary to monitor her condition and promptly notice developing complications of various origins.

It is important to remember that in the first month after surgery it is better to limit sexual contacts or completely eliminate them. Such a restriction will help to avoid infectious processes and suture dehiscence. Other types of physical activity that can negatively affect a woman’s health are also not recommended.

Restrictions are also imposed on water procedures. A woman is prohibited from taking a bath (shower only) for at least two weeks. After all water procedures, the seams are subject to antiseptic treatment to prevent infection and inflammation.
A woman needs to move (walk outside) so that the recovery processes in the body become more active. Lying down for a long time after surgery is not recommended.

How is laparoscopic cyst removal performed?

Conclusion

If there is a need to remove the ovarian bush, the doctor must assess the woman’s general condition, her medical history and test data in order to choose the optimal type of intervention. A correctly chosen operation will help relieve a woman of pathology, lead to a rapid restoration of good health, and improve well-being.

An ovarian cyst is a single-chamber or multi-chamber cavity filled with fluid or blood. Pathology is detected at any age - from menarche to menopause. Some cysts do not cause much discomfort, others lead to menstrual irregularities and infertility. Sometimes, under the guise of a relatively harmless formation, ovarian cancer is hidden, requiring a special approach to therapy.

What is indicated when a cyst is detected on the ovary - drug treatment or surgery? This question worries every gynecologist’s patient, but it is not always possible to give a definite answer to it. The choice of treatment method depends on the type and size of the cyst, its growth rate, concomitant pathology, the woman’s age and other factors. Before making a decision, you need to evaluate all available data and weigh the possible risks. In controversial situations, it would not hurt to consult an independent specialist.

Treatment methods for ovarian cysts

In modern gynecology, there are two treatment options:

Conservative therapy involves exclusively non-invasive intervention. The woman is prescribed a course of medications - hormonal or non-hormonal. For some ovarian formations, anti-inflammatory drugs are indicated. Don't forget about physiotherapy methods;
Surgical intervention is the mechanical elimination of a pathological focus. Both excision of the formation and removal of the entire affected organ are practiced.

In medicine, there are 2 methods of treating ovarian cysts - conservative and surgical.

You can treat an ovarian cyst with only one method or use a combination of them. In some cases, hormonal therapy may be prescribed before and after surgery. The techniques are not always interchangeable. In difficult situations, to get rid of the pathology, a woman will have to go through all possible stages of treatment.

Let's take a closer look at the advantages and disadvantages of each method.

Conservative therapy

Advantages:

No invasive intervention is performed on the woman’s body;
It is possible to save the ovaries;
It can be carried out at home, in a antenatal clinic or a day hospital. Hospitalization in a 24-hour department is not always necessary;
Does not require special training.

Flaws:

High risk of side effects of medications;
Does not apply to organic ovarian cysts: dermoid, paraovarian, serous;
Does not always bring the desired effect;
After discontinuation of the drug, a relapse of the disease is possible;
Not suitable for all women (during menopause, the choice of medications is limited).

Types of ovarian cysts that are not treated with medication.

Surgery

Advantages:

Allows you to radically get rid of the pathological focus;
Suitable for women of any age;
Low probability of disease recurrence.

Flaws:

Invasive intervention - an incision of soft tissue is assumed;
Risk of postoperative complications;
The need for careful preparation.

It is important to know

The operation has one undeniable advantage over drug treatment. Surgical intervention allows you to radically remove a suspicious tumor and avoid its malignancy. Taking medications prescribed for benign ovarian processes does not affect the growth of cancer cells and does not help prevent the development of metastases.

Factors influencing the choice of treatment method

Important criteria:

Type of cyst. Functional formations - luteal and follicular cysts - often do not require drug treatment. They are able to regress on their own within a short time. Endometriomas respond well to hormonal therapy. Dermoid, serous and paraovarian cysts are not treated with medication;
Education size. Surgery is necessary if the size of the lesion exceeds 10 cm. As it grows, the risk of developing complications increases significantly. For small functional formations, drug therapy is allowed;
The woman's age. At menopause, all ovarian tumors are removed. During reproductive age, some conditions are amenable to conservative treatment;

Reproductive plans. It is recommended to remove the formation before conceiving a child, since during pregnancy it can interfere with the development of the fetus. An exception is made only for small lesions up to 30 mm in size;
Preliminary survey data. If ultrasound or MRI reveals signs of a malignant tumor, surgery is mandatory. Surgical treatment is also recommended if tumor markers increase (CA-125, CA 19-9, HE4);
Presence of complications. If the cyst ruptures or twists, surgery cannot be avoided.

It is important to know

If the doctor insists on surgical treatment, and the patient does not agree with his recommendations, you can always get a second opinion. To do this, you should contact another specialist. After consulting an independent expert, a final decision can be made.

Principles of drug therapy

Indications for conservative treatment:

Detection of functional ovarian cyst (follicular, luteal);
Detection of endometrioma;
The size of the formation is up to 8-10 cm (discussed individually);
The woman is under 50 years of age (or before menopause);
Absence of complications and severe symptoms causing significant discomfort;
There are no signs of tumor malignancy.

There are no clear criteria regarding the size of education. The question of the treatment method is decided individually, taking into account the clinical picture of the disease and the presence of concomitant pathology.

Conservative therapy involves taking hormonal drugs:

Combined oral contraceptives. Treatment uses drugs based on strong gestagens with a pronounced antiproliferative effect (gestodene, desogestrel, dienogest, levonorgestrel). Assigned according to the standard 21+7 or 24+4 scheme;
Progestin drugs. Used from the 5th to the 25th day of the cycle, continuously or according to another scheme specified by the doctor;
Gonadotropin-releasing hormone agonists. Prescribed for endometrioid cysts. They are used in conjunction with low doses of estrogen to suppress unwanted side effects.

During conservative therapy, a woman may be offered drugs based on gestagens.

The course of drug treatment for functional cysts lasts 3 months. For endometrioma, hormonal medications are prescribed for 3-6 months. If there is no effect, the issue of surgery is decided.

The goal of treatment is to achieve a reduction or complete regression of the formation, eliminate unpleasant symptoms and reduce the risk of complications. Drug therapy can be prescribed when planning pregnancy, and also as one of the stages of preparation for surgery.

Other medicines:

Nonsteroidal anti-inflammatory drugs to reduce pain;
Vitamins and immunostimulants to maintain the body's defenses.

Conservative therapy does not guarantee complete elimination of ovarian cysts. Only with functional formations is there a chance that the lesion will resolve and will not reappear. In the case of endometriosis, there is an effect as long as the woman takes the medications prescribed by the doctor. The effect of the medications lasts no more than a year, after which the endometrioid cyst may begin to grow again. Conservative therapy for this pathology is used as a means to gain time to conceive and bear a child.

Features of surgical treatment

Indications for surgery:

Detection of dermoid, paraovarian or serous ovarian cyst. These formations are not amenable to drug therapy;
Suspicion of a malignant tumor;
The size of the pathological focus is more than 10-12 cm;
Rapid growth in education;
Detection of ovarian pathology during menopause;
Development of life-threatening complications;
Pregnancy planning.

When planning a pregnancy, experts usually suggest surgical removal of the cyst so that the pathology does not interfere with conceiving and bearing a child.

On a note

In the absence of complications, the operation is carried out as planned after preparation and testing. In case of torsion of the leg, rupture of the formation or its suppuration, surgery must be performed urgently.

The best option for removing the formation is laparoscopic intervention. If minimally invasive surgery is not possible, laparotomy is indicated.

Surgical treatment options:

Cystectomy. Only the pathological focus is removed. Healthy tissue is practically not damaged, the ovary remains. It is considered the best option for women of reproductive age, including those planning pregnancy. It is carried out when the formation is small, when it is possible to remove the cyst within intact tissues;
Wedge resection of the ovary. It is used when it is impossible to remove only the formation, but there are no indications for removing the ovary. A small section of the organ is excised. During the operation, it is important not to damage the ovarian stroma and follicular apparatus. Tissue trauma threatens depletion of the ovarian reserve and infertility;
Ovariectomy. The ovary is removed along with the pathological formation. It is used for large cysts when there is no healthy tissue left. It is also practiced during postmenopause: after the end of the reproductive period, there is no point in leaving a potential source of malignant tumors in the body.

The photograph shows one of the stages of laparoscopic removal of an ovarian cyst:

When ovarian cancer is detected, the scope of the operation expands to removal of the uterus, appendages, and leaves of the greater omentum. A revision of the abdominal cavity and regional lymph nodes is indicated.

Surgical treatment in most cases radically relieves the woman of the problem, but relapse of the disease cannot be completely excluded. If the factors contributing to the growth of the tumor are not eliminated, it may grow again after some time - months or years.

FAQ

When choosing a treatment method, patients ask the gynecologist the following questions:

Is it always necessary to remove an ovarian cyst?

No, not all formations are subject to mandatory surgical treatment. Functional cysts can even spontaneously regress without surgery. Endometriosis often goes away with the onset of menopause.

Do I need to remove an ovarian cyst if it does not bother me and is not growing?

It all depends on the type of education. If we are talking about functional cysts, dynamic observation is sufficient. If a dermoid or paraovarian cyst is detected, surgery is inevitable, but it can be postponed for some time. It is better to remove serous formations immediately after diagnosis, as the risk of malignancy is high.

When is a cyst on the ovary cut out, and when is the entire organ removed?

The extent of the operation depends on the size of the lesion, location, age of the woman and other factors.

How dangerous is surgery for ovarian cysts?

Laparoscopic intervention is tolerated quite well. After the operation and recovery from anesthesia, short-term weakness, pain in the lower abdomen, and headache are noted. Recovery after laparoscopy takes 12-14 days. The menstrual cycle returns to normal within a month. You can plan a pregnancy 3-6 months after endoscopic removal of the formation. Proper selection of anesthesia and compliance with safety precautions can reduce the risk of possible complications.

After laparoscopic surgery, a woman recovers quickly because this treatment method is minimally invasive.

Can menopause occur after removal of an ovarian cyst?

In most cases, the operation goes well and menstrual function is not affected. It happens that when trying to remove a cyst or perform an ovarian resection, healthy tissue containing follicles is injured. A decrease in the supply of follicles can lead to an early onset of menopause and the appearance of its characteristic symptoms: hot flashes, emotional lability, decreased libido, etc.

How much does it cost to remove a left/right ovarian cyst?

The price is determined by the volume of the operation and the selected access. The average cost of laparoscopic cystectomy in Moscow clinics is 25-30 thousand rubles. According to the compulsory medical insurance policy, the operation is performed free of charge for the patient.

What are the risks of refusing treatment?

Treatment can only be avoided if there are functional ovarian formations. But even luteal and follicular cysts do not always resolve on their own, and then surgery is required. Refusal of surgical intervention threatens the development of complications:

Infertility. Follicular and endometrioid cysts prevent pregnancy and can also interfere with pregnancy;
Malignization. Not all cysts develop into cancer, but any ovarian formation is considered potentially dangerous and requires mandatory monitoring. Tumors detected in postmenopause deserve special attention. After 50 years, the risk of developing malignant tumors increases;

Adenocarcinoma in section. Some types of cysts can become malignant, so you should not neglect the treatment of tumors.

Education gap. The larger the size of the cyst, the higher the likelihood of damage to its capsule. The rupture leads to profuse hemorrhage into the ovary. The development of peritonitis is possible;
Cyst torsion. If the tumor is located on a thin stalk, it may twist. This complication threatens necrosis of ovarian tissue;
Chronic pelvic pain. The growing formation leads to stretching of the ovarian capsule. A large tumor presses on the nerve plexuses. All this leads to the appearance of constant aching pain in the lower abdomen and lower back. With endometriosis, pain occurs during menstruation; with other formations, it is not associated with the day of the cycle.

It is important to know

If you suspect an ovarian cyst, do not delay visiting a doctor. It is necessary to assess the nature of the formation, undergo a full examination and determine the diagnosis. This is the only way to choose the optimal treatment and avoid the development of health and life-threatening complications.

The nuances of using folk remedies in the treatment of ovarian diseases

Traditional medicine recipes are used in the treatment of pathology of the appendages only as an adjunct and exclusively for functional formations.

Alternative medicine for the treatment of ovarian cysts can help strengthen the immune system, but cannot get rid of the tumor itself.

Alternative methods in the treatment of endometriosis are allowed, but not at the expense of the doctor’s recommendations. The following options have worked well:

The use of “female” herbs (red brush, celandine, boron uterus, etc.) in complex therapy of hormonally active ovarian cysts. Decoctions and infusions normalize hormonal levels and speed up recovery;
Hirudotherapy can be used to improve blood flow in the pelvic organs and only under the supervision of a physician;
The effectiveness of acupuncture in the treatment of ovarian cysts has not been proven, but attempts to use it continue.

Mature teratoma, paraovarian cyst and true tumors cannot be treated with folk remedies. If such a pathology is detected, surgical treatment is indicated. It is possible to use herbal medicine in the postoperative period to stimulate the immune system and speed up the recovery of the body.

Useful video: in what cases is it necessary to remove an ovarian cyst?

Patient's review of surgical removal of an endometrioid cyst

Laparoscopic surgery is recognized as the “gold standard” in the treatment of ovarian pathology. The manipulation is carried out without an incision in the abdominal wall. Minimal tissue trauma reduces the risk of complications and preserves reproductive health.

Laparoscopy of ovarian cysts is considered the optimal method for treating pathology in adolescents and women of reproductive age. Surgery is indicated if conservative therapy is ineffective and the disease progresses. Laparoscopic intervention is also performed if complications develop. The introduction of a minimally invasive procedure into gynecological practice can significantly shorten the rehabilitation period and speed up recovery.

Advantages of laparoscopy over abdominal surgery

In gynecology, operations are performed using three different approaches:

Laparotomy (abdominal surgery) - an incision is made in the abdominal wall. All manipulations are carried out in the formed surgical wound;
Laparoscopy – the doctor performs the necessary actions through small punctures in the abdominal wall. Special tools are used to perform manipulations. A video sensor is attached to one of them, and the doctor sees on the screen everything that happens in the operated area;
Transvaginal access - operations are performed through the vagina. Practiced under hysteroscopy control.

Transvaginal surgery is one of the available types of treatment for ovarian cysts.

A comparison of abdominal surgery and laparoscopy favors a minimally invasive procedure:

Minimal damage to intact tissues (not involved in the pathological process);
Less intraoperative bleeding;
A gentle effect on the pelvic organs adjacent to the ovary (intestines and bladder) accelerates their recovery after surgery;
Possibility of performing complex manipulations using atraumatic instruments;
Low risk of developing postoperative complications (infection, formation of adhesions, bleeding, formation of a ventral hernia, intestinal paresis);
Fast recovery after surgery.
Minimum restrictions in the rehabilitation period and quick discharge from the hospital;
No scar on the skin. After laparoscopy, almost imperceptible puncture marks remain, which can be easily hidden under underwear.

One of the advantages of laparoscopy is the almost invisible puncture marks after surgery.

Laparoscopy is definitely better than abdominal surgery, but the doctor is not always able to perform minimally invasive intervention. For endoscopic removal of a cyst, a number of conditions must be met:

Availability of specialists capable of performing complex operations;
Availability of equipment for laparoscopy;
There are no contraindications for minimally invasive intervention.

The choice of access is finalized after evaluating all available data. In some cases, it is possible to remove an ovarian cyst only with abdominal surgery.

The only disadvantage of laparoscopy is its high price. In private clinics in Moscow, the cost of the operation reaches 30 thousand rubles. The price is determined by the volume of intervention and the complex of rehabilitation procedures. Patients of public clinics do not need to think about how much it costs to treat a cyst. According to the compulsory medical insurance policy, the operation is performed free of charge for the woman (subject to the availability of equipment and indications).

Indications for minimally invasive surgery

Removal of an ovarian cyst using laparoscopic access is carried out in the following situations:

Lack of effect from treatment of ovarian retention cyst (follicular or luteal). In 80% of cases, these formations spontaneously regress within 3 months. If the disease progresses, and during the specified period the cyst has decreased by less than half or has not responded to therapy at all, its removal is indicated;
Detection of a growing paraovarian or other ovarian cyst. These formations are not treated conservatively and do not disappear spontaneously. The only way to get rid of the disease is through surgery;

Paraovarian ovarian cysts cannot be treated with medication; such formations can be removed laparoscopically.

Detection of a progressive dermoid ovarian cyst measuring 3 cm or more. Such a formation can grow almost endlessly. It cannot be treated conservatively; mandatory removal is indicated;
Lack of effect from therapy for endometrioid cysts or rapid growth of formation;
Infertility due to ovarian pathology;
Suspicion of a malignant tumor;
Development of complications: torsion of the cyst stalk, rupture of the capsule, infection;
Primary detection of any ovarian mass during menopause.

It is important to know

Laparoscopic surgery is possible for tumor sizes up to 10-12 cm (with modern equipment - up to 15-17 cm). If a giant cyst is identified, the question of laparotomy is raised.

If a woman has a large cyst, then laparoscopy in this situation is impossible; its removal is performed laparotomy.

Contraindications to laparoscopic intervention

A minimally invasive procedure is not performed in the following circumstances:

Obesity III-IV degree. A large layer of subcutaneous fat does not allow inserting the instrument and performing the necessary manipulations;
Pronounced adhesions after operations on the pelvic organs;
Diffuse peritonitis (inflammation of the peritoneum) is a consequence of cyst rupture or suppuration;
Late pregnancy.

In these situations, abdominal surgery with opening of the abdominal cavity is indicated.

There are relative contraindications to laparoscopy:

Pathology of the heart and blood vessels in the stage of decompensation;
Kidney and liver failure;
Blood clotting disorders that cannot be corrected;
State of shock;
Severe exhaustion (cachexia);
Acute infectious diseases.

When such conditions are identified, their correction is indicated. The operation is postponed until body functions are restored.

One of the contraindications to laparoscopy is severe exhaustion of the body (cachexia).

Preparing for surgery

Before any surgical intervention, the patient must undergo tests and undergo some specialist examinations. This approach helps to fully prepare for surgery, identify concomitant pathologies and reduce the risk of complications. Based on the examination results, the gynecologist determines the timing and method of surgical intervention, and the anesthesiologist selects the drug for anesthesia.

List of tests:

General blood analysis;
Blood chemistry;
Coagulogram – clotting test;
Determination of Rh and blood group;
General urine analysis;
Screening for infections: HIV, syphilis, viral hepatitis B and C;
Survey smear and bacteriological culture of flora;
Smear for oncocytology;
Colposcopy;
Consultation with a gynecologist;
Ultrasound of the pelvic organs. Determination of the size of the ovarian cyst, its location, and the state of blood flow. Identification of concomitant gynecological pathology;
Tumor marker test (CA-125, CA-19) for diagnosing a malignant tumor;
Electrocardiography;
Fluorography;
Consultation with a therapist;
Oncologist consultation.

Among the examinations that a woman must undergo before surgery, the fluorography procedure is mandatory. Women over 40 years of age additionally need to undergo a colonoscopy, mammography and endometrial aspiration biopsy.

Tests must be taken in advance before the planned operation. It is important to remember that some tests are only valid for 10 days (blood and urine tests), while others are valid for up to 3 months. If contraindications are identified, the doctor may reschedule the operation and recommend that the patient undergo treatment with an appropriate specialist.

Preparation for laparoscopy is not limited to tests. Before the procedure you must:

Exclude from the diet foods that increase gas formation in the intestines: legumes, cabbage, black bread, etc. The diet begins 2-4 days before the procedure;
Perform a cleansing enema on the eve of surgery;
Avoid eating 12 hours before the procedure. On the day of laparoscopy, it is forbidden to eat or drink;
Take a hygienic shower without using cosmetics;
Shave your pubic hair;
Take sedatives (as prescribed by your doctor);
Prepare compression stockings (wear on the day of surgery, help prevent thromboembolic complications).

On the eve of the planned operation, the patient is examined by an anesthesiologist and decides which anesthesia is best to use: general or epidural. In the first case, the patient falls asleep and regains consciousness after completion of all manipulations. With an epidural, only the lower part of the body is switched off. The woman remains conscious. The choice of pain relief method is determined by the extent of the surgical intervention, the patient’s health status and other factors.

One type of anesthesia during laparoscopy can be general anesthesia (anesthesia): it all depends on the woman’s health condition and the plan for the operation.

Technique for laparoscopic removal of ovarian cysts

Progress of the operation:

Transfer the patient to the Trendelenburg position. The head end of the table tilts down. The intestine moves towards the diaphragm and opens access to the pelvic organs;
Treatment of the surgical field with antiseptic solutions;
Puncture of the abdominal cavity and filling it with carbon dioxide. This tactic helps to increase the distance between the internal organs and free up space for manipulation;
Introduction to the puncture of a laparoscope - an instrument with a camera and a light source. The laparoscope is advanced towards the ovaries;
Creation of punctures in the lateral abdomen and insertion of manipulators. Performed under video control;
During diagnostic laparoscopy, the doctor examines the organ and gives his opinion. If an ovarian cyst is detected, the operation can turn into a therapeutic one, and the formation will be immediately removed. If adhesions are present, the laparoscopic equipment is rolled up and the abdominal cavity is opened (laparotomy);
Removal of a cyst or ovary;
Stop bleeding;
Removing tools and removing carbon dioxide;
Applying sutures and bandages to puncture sites.

Thanks to the laparoscope, damage to the abdominal organs during surgery is minimized, since the doctor sees everything on the screen.

You can see in detail how laparoscopic surgery for ovarian cysts is performed in the video. Removal of a ruptured follicular cyst (left) and dermoid cyst (right) is indicated:

The extent of surgical intervention is determined during the operation:

Cystectomy – desquamation of the cyst. It is carried out when the ovarian tissues are intact and there are no signs of malignancy. Recommended for women of reproductive age and adolescents. Average cost – 25 thousand rubles;
Ovarian resection - removal of a small section of the organ along with the cyst. It is performed if part of the ovary is functional and not affected by the pathological process. Price in Moscow clinics – 18-22 thousand rubles;
Ovariectomy - removal of the ovary along with the cyst. Indicated for pronounced changes in organ tissue (necrosis, replacement with connective tissue). Often performed during menopause. Cost – from 20 thousand rubles;
Adnexectomy – removal of the cyst, ovary and fallopian tube. It is performed in case of severe disease, spread of the process to neighboring organs, or detection of cancer. Price – from 18 thousand rubles.

Laparoscopy of a cyst of the right and left ovary is performed in the same way. There are no differences in the technique of execution, duration or volume of manipulations.

The photo below shows one of the stages of laparoscopy for endometrioid ovarian cyst:

The following photo schematically shows the progress of laparoscopic removal of an ovarian cyst:

It is important to know

Removing one ovary does not affect a woman's reproductive health. The second ovary fully copes with its task and can fully function until the onset of natural menopause. After an oophorectomy, with intact appendages on the opposite side, a woman can conceive, carry and give birth to a child.

Observation in the postoperative period

After laparoscopy is completed, the woman comes out of anesthesia and is transferred to the ward. In serious condition, the patient is transferred to the intensive care unit, but after a minimally invasive intervention, the need for such a measure rarely arises.

In the first hours after the operation, the woman lies in the ward, after which she begins to gradually sit up, stand up and walk. The patient begins to move around quite quickly, since there are no large incisions or pain. By the end of the first day, liquid food is allowed. When bowel function is restored, the woman is switched to a gentle diet.

Principles of nutrition after laparoscopic surgery:

It is recommended to avoid foods that cause gas formation in the intestines. Some vegetables (cabbage) and fruits (grapes), legumes, fresh baked goods, and brown bread are prohibited;

After surgery, you should not eat foods that cause bloating.

Food is steamed, oven-baked or boiled. You should not eat fried foods;
Frequent split meals are practiced - 5-6 times a day;
It is recommended to drink up to 1.5-2 liters of liquid per day. Berry fruit drinks, fruit compotes, and herbal tea are allowed. Carbonated drinks, coffee, black tea are prohibited.

Recovery after laparoscopic removal of an ovarian cyst takes about 5-7 days. On the 3-6th day the patient is discharged home. The length of hospital stay depends on the woman’s condition and the course of the postoperative period.

Sick leave after laparoscopy is issued for 7-14 days. At the end of this period, the woman can return to her normal life with some restrictions.

In the first 2-4 weeks after surgery it is prohibited:

Be sexually active;
Lift heavy objects (more than 3 kg);
Exercise;
Visit the sauna and solarium;
Practice any thermal procedures;
Take a bath (you can use a shower);
Visit the pool and beach.

For a month after surgery, a woman needs to give up various types of thermal procedures, sports and heavy physical activity.

Care of postoperative sutures begins on the first day after surgery. The puncture sites are treated with antiseptics. A sterile gauze bandage is applied over it. Stitches are cleaned and the dressing is changed daily. During the procedure, the doctor carefully examines the wound. Normally, healing should occur without significant swelling and signs of inflammation (the appearance of pus, suture dehiscence).

The sutures are removed on the 5-7th day. If permanent suture material was used during the operation, the threads will dissolve on their own within a week. Stitches are removed in a antenatal clinic or in a gynecological hospital.

Postoperative follow-up also includes:

Daily monitoring of body temperature. A slight increase in temperature up to 37.5 degrees is allowed in the first three days after surgery;
Blood pressure measurement;
Assessment of pulse and respiratory rate;
Urinary control. If the patient cannot empty the bladder on her own, catheterization is performed;
Control of bowel function. For constipation, a cleansing enema is indicated.

After discharge from the hospital, the patient comes under the supervision of a doctor at the antenatal clinic. A control ultrasound is performed after 1, 3 and 6 months, then every six months.

After discharge from the medical institution, the woman should be observed by her gynecologist, where she undergoes control ultrasound examinations.

Physiotherapy to stimulate blood flow in the pelvic organs;
Taking absorbable medications to prevent the formation of adhesions;
Protection against unwanted pregnancy with combined oral contraceptives.

The menstrual cycle is restored a month after the operation. Periods may be delayed by up to 1-2 weeks. You can plan a pregnancy 3-6 months after removal of the cyst. Before conceiving a child, it is necessary to undergo a control examination by a gynecologist and have an ultrasound scan. If the postoperative period progresses well, a woman usually does not have problems getting pregnant.

Complications after surgery

Undesirable consequences of the postoperative period

Bleeding. Usually relieved during surgery. Less commonly occurs after suturing punctures in the early postoperative period;
Wound infection. During laparoscopy, it is practically not observed, since there is no contact with the skin and tissues of the abdominal wall. Accompanied by an increase in body temperature and the appearance of pain in the lower abdomen;
Seams coming apart. It is detected in the first days after surgery. Tissue integrity is restored;
Damage to the pelvic organs. It is detected during surgery or in the first days after it. Accompanied by a sharp deterioration in the patient's condition.

When using modern equipment, following the rules of asepsis and antisepsis and highly qualified surgeons, the likelihood of complications developing is minimal.

If you follow all the rules during the operation and the postoperative period, as a rule, there are no complications.

Translated from Greek, cyst means bubble. This abnormal formation, containing fluid inside, can appear on almost any organ: the brain, teeth, kidneys, skin, ovaries and many others. The size of the cyst, the reasons for its appearance, its structure and contents depend on the organ on which it was formed, the age of the patient, and his hormonal levels.

In women, this disease most often affects the ovaries. Unfortunately, most girls who face this problem are of reproductive age. Much less often, doctors have to remove takre formation in postmenopausal women.

What is an ovarian cyst

In appearance, the cyst resembles a bubble on a thin stalk, inside of which there is liquid. It is not a real tumor, although classified as tumor-like processes. For a long time, this disease can remain undetected.

Reasons for appearance

Despite the vast experience of modern gynecology, the physiological mechanism that triggers the growth of cysts has not been fully studied. Hormonal imbalance is one of the reasons for its appearance, but it is not decisive. Most likely, the process of cyst growth starts when several factors occur at once:

Heredity
Stopping lactation with medication
Menstruation that came before 11 years of age
Obesity
Hormonal contraception (if used continuously for more than 5 years)
Inflammation
Abortion
Infection
Infertility
Smoking
Strict diets
Endocrine diseases
Cycle disorders
Stress

Cyst types

Usually, pathology forms at the place where the follicle matured. Education can be divided into two types:

Temporary
Abnormal

Throughout life, a cyst on the ovary may appear and resolve on their own several times, so the woman will never know that she had this pathology. Such a cyst is called functional; gynecologists also call it temporary. Troubles in the form of ruptures or torsion of the legs are extremely rare.

This type of disease almost never manifests itself, there are no symptoms, and people learn about it by chance, during an examination.

The second type of cyst is abnormal. This pathology can manifest itself with the following symptoms:

This type requires serious treatment; if possible, the gynecologist will try not to use surgery. First, the patient will be prescribed hormonal medications with vitamins A, B and C. If a woman is overweight, the menu must be adjusted.

After 3 month cycles, if the process has not reversed, the doctor decides to surgically remove the cyst.

Cyst removal options

Surgical removal of the resulting pathology is a fairly serious procedure, so many women tend to adopt a wait-and-see approach and try to find out how to remove a cyst with medication or folk remedies. Such actions are justified only in relation to temporary cysts.

In other cases, it is better to resort to surgical removal. Only this radical type of treatment can guarantee the prevention of peritonitis, infertility, and that the formation will not degenerate into cancer.

The main decision on how to remove the cyst is made by the doctor. The final answer depends on many factors, such as: location, age and size of the cyst; the woman’s health status (diagnosis will answer this question); her plans for offspring. If all the collected data suggests that it is possible to remove the cyst using laparoscopy, a day of surgery is scheduled.

Laparoscopy is one of the least traumatic interventions in modern surgery. This operation makes it possible to avoid complications with a high degree of probability and minimizes the stress that the body experiences. Epidural anesthesia may be used.

The cyst is removed using several small punctures (no more than a centimeter) in the abdominal cavity. Special metal tubes called tubes are inserted into these holes. The doctor passes a lighted camera through one of the tubes, and surgical instruments through the rest.

Before directly removing the cyst, the doctor examines the remaining pelvic organs to exclude possible pathologies. To do this, the doctor needs to introduce air (nitrous oxide) into the abdominal cavity. Gas is introduced in a volume of 3000 cm3, the abdominal wall rises and does not interfere with the examination.

To ensure that during removal of the cyst it does not burst and fluid does not get on other organs, the doctor punctures it. The liquid is completely aspirated, then the capsule is removed. Most often it is removed along with the part of the ovary on which it formed. If complete removal of the ovary is indicated, the doctor removes it through laparoscopic punctures.

Blood loss is minimal, since the doctor performs coagulation (cauterization) of all damaged vessels. Small punctures, no more than 1 cm, allow you to remove even large capsules.

After complete removal of the cyst, the doctor must once again carefully examine the neighboring organs, check for bleeding vessels, rinse the abdominal cavity, and remove gas. If the doctor deems it necessary, he will install drainage for several days. The incisions are so small that single sutures will be sufficient.

A woman can get up, take care of herself and move around without assistance the very next day. You will need to take antibiotics for two weeks. Stitches can be removed after a week.

Culdoscopy

In some cases, cyst removal is carried out using culdoscopy, when an optical device and instruments are inserted through the vagina, namely through its posterior fornix. During culdoscopy, the patient is conscious and epidural anesthesia is used. The air is not forced into the abdominal cavity artificially, but is drawn through the puncture under the influence of negative pressure inside.

After removing the cyst and completing all the manipulations, the doctor asks the woman to push to remove air from the abdominal cavity. If this is not done, the patient will experience discomfort in the diaphragm. The puncture site is sutured.

Provided the culdoscopy is successfully completed, the patient can get up on her own in the evening of the same day and go home the next day. Stitches are usually removed after a week.

Modern doctors try to resort to open abdominal surgery as rarely as possible. This surgical procedure requires general anesthesia, and it puts a lot of stress on the body, especially on the heart.

If the patient is obese, the cyst is accompanied by inflammation, or there is a suspicion of its malignant degeneration, a laparotomy (abdominal surgery) is performed. This type of surgical removal of the cyst is also indicated if the woman has previously suffered peritonitis. Adhesions that form in the abdominal cavity make it impossible to expand it with air and perform laparoscopy.

The doctor gains access to the affected organ by cutting the anterior wall of the abdominal cavity. Removal of a cyst involves a small area of ovarian tissue; if it cannot be preserved, the organ is removed completely. Rehabilitation after laparotomy may take more than 2 weeks.

Regardless of how the operation was performed, the resulting tissue will be sent for histological examination. It will answer what type of cyst was removed, whether there was a risk of cancer, and what treatment or prevention should be prescribed to the patient.

Removal of a cyst during pregnancy

In order for the process of bearing a child to bring only pleasant troubles to the expectant mother, it is necessary to prepare for it in advance. It is advisable to undergo all the necessary examinations, take tests, and prepare mentally. Unfortunately, despite all precautions, an ovarian cyst appears in 1 out of 1000 pregnant women. It is most often discovered in the early stages, but this formation can appear in any of the 9 months of pregnancy.

Treatment options for cysts during pregnancy:

Treatment and removal of a burst cyst

The right ovary is supplied with blood more intensely than the left, and the arteries supplying it with blood have higher pressure. This explains the fact that the cyst on the right ovary ruptures 4 times more often than on the left. Symptoms of rupture:

Sudden, cutting pain in the lower abdomen, sometimes near the navel. The pain radiates to the lower back, hip, even anus. Gradually its intensity decreases and its area increases. Sometimes, discomfort in the lower abdomen and groin, mild dull pain precedes an acute attack. This is due to swelling and abundant blood supply to the ovary.
Weak bleeding. The less pain becomes, the weaker the discharge.
Dizziness, possible loss of consciousness. Weakness, cold sweat, shortness of breath.
Fever, chills.
Possible vomiting.
The heart rate increases. If you measure the pressure, you will first find a sharp increase, and then a smooth decrease (blood will flow into the abdominal cavity, and the pressure, due to this process, will fall).
If blood loss is significant, hemorrhagic shock may develop

The number of patient complaints directly depends on the amount of blood loss The larger it is, the brighter the clinical picture and the more its manifestations.

In some cases, if the blood loss is small, the woman’s general condition is satisfactory, and there are no pronounced signs of bleeding into the abdominal cavity, conservative treatment is possible. It consists of strict bed rest, taking hemostatic agents, analgesics, and applying cold to the lower abdomen.

In case of large blood loss, serious condition of the woman and severe pain, surgical treatment is prescribed(laparoscopy or laparotomy). The purpose of the operation is to remove the cyst and coagulate the damaged vessels, which is necessary to stop the bleeding. If it is not possible to save the ovary, the doctor removes it completely.

Emergency operations are always much more difficult than planned ones. The doctor does not have much time for thorough preparation; there is no opportunity to take into account all the nuances. With a planned procedure, the doctor has time to fully diagnose the patient. That is why gynecologists insist on regular preventive examinations, which help to identify the disease and prevent critical conditions. Removing a cyst during a planned operation is safer for the patient than during an emergency operation in the event of a cyst rupture.

Whether it is necessary to remove an ovarian cyst is a serious question. Surgical removal of an ovarian cyst is usually prescribed when therapeutic and drug treatment is impossible or unsuccessful, or a cancerous process is suspected. Only a specialist can decide whether to remove an ovarian cyst or not.

If after 3–4 menstrual cycles or under the influence of medications no positive changes in the resorption of the node are observed, the ovarian cyst is removed unless there are contraindications.

The surgical treatment tactics are determined by:

type of neoplasm, its size;
stage of the disease and degree of progression;
oncological prognosis;
associated pathologies.

How is the operation performed? The basic principle with any surgical method is to handle the ovary as carefully as possible to preserve its functioning.

Methods of surgical treatment

What method should be used to remove a tumor-like node?

Several methods are used to remove a cyst:

This is the most painless method for the patient.
Cyst puncture. It is used only when the formation is small and there are no signs of inflammation or cancer. A nozzle is inserted through the abdominal wall under local anesthesia, with which the wall of the capsule is pierced and the contents are removed from the cavity, after which sclerosis occurs (collapse of the walls).
Abdominal surgery or laparotomy. An open type of surgical intervention with a deep incision in the abdominal wall (up to 10–15 centimeters), performed under general anesthesia.

Laparotomy of the cyst

Although laparoscopy is more often used among surgical methods, there are a number of justified indications for which abdominal surgery to remove an ovarian cyst is prescribed. In case of a complicated process, it is not always possible to carry out the required amount of treatment using laparoscopy.

Emergency indications for surgery are the following urgent cases:

perforation (rupture) of the cyst capsule with leakage of internal exudate into the abdominal cavity;
suppuration of the cyst tissue with further penetration of pus into adjacent organs;
twisting of the leg-ligament, which leads to the knot suppurating;
hemorrhage into the peritoneum.

Such cases pose a direct threat to life, as they can quickly lead to blood poisoning, shock, massive bleeding and an irreversible coma.

Indications for routine removal of an ovarian cyst by laparotomy:

large neoplasm over 80 – 100 mm;
active growth in a short time;
development of a tumor-like node in the deep tissues of the gonad;
adhesions in the area of the reproductive organs;
suspicion of a cancer process or a confirmed diagnosis of oncology.

Do you use folk remedies?

YesNo

Advantages of laparotomy

Excision of a cyst on the ovary by abdominal surgery has a number of significant advantages:

Provides wider access to all pelvic organs.
Allows for emergency removal of a node in emergency conditions with examination of neighboring organs, and to take action if other pathologies are detected.
Provides an opportunity for a detailed study of the reproductive organs, tissue, lymph nodes, and areas with probable cancerous changes.
Provides the possibility of enucleation of an ovarian cyst (excision of the formation without opening the capsule), which eliminates the entry of pus or exudate into the peritoneal cavity and associated complications.
Allows for surgical intervention of any volume and complexity, which is especially important for malignant changes, when it is impossible to determine the degree of development of the process before surgery. At any time, you can expand the surgical field for manipulation and remove the uterus and appendages. In this case, complete excision of the affected organs takes place without the risk of heavy bleeding.
It is characterized by technical simplicity and does not require complex tools and equipment.

Contraindications

Laparotomy of an ovarian cyst in women has certain contraindications in which it can be dangerous. These include:

abnormally low blood clotting (hemophilia) and blood diseases;
persistent hypertension;
conditions with a high risk of cerebral hemorrhage, heart attack;
acute respiratory tract infections, severe asthma;
intolerance to anesthetics required for general anesthesia.

Preparation for laparotomy

Before surgery, the following studies must be performed:

blood group test, general and biochemical examination, Rh factor;
general and special urine analysis for kidney diseases;
coagulogram or determination of blood clotting (INR, PTI);
tests for sexually transmitted infections, HIV.

5 - 7 days before surgery, limit foods that provoke intestinal gas formation and allergies: fatty meats and smoked foods, carbonated drinks, beer, fruits, cabbage, legumes, black bread, spices, sweets made from flour and butter, milk.

The day before surgery:

It is necessary to empty the intestines using laxatives and an enema. The less space the intestinal loops take up, the more volume remains for surgical manipulation.
Stop eating 14 hours before surgery. A light dinner is allowed until 18:00, you can drink tea and water until 22:00.
On the day of the operation, do not eat breakfast or drink, so that during anesthesia a gag reflex does not occur and the airways are not blocked by stomach contents.

Carrying out laparotomy

How is the operation to remove a cyst performed? First, the skin is treated with antiseptics. The surgeon makes a cavity incision, for which two methods are used:

The incision is inferomedian, which is made vertically along the line between the pubic bone and the navel area.
Laparotomy according to Pfannenstiel. This is the main method in gynecology, in which a transverse incision is made along the fold of skin in the lower abdomen above the pubis. After healing, the scar will be invisible under the fold.

Then the surgeon opens the peritoneum layer by layer.

During laparotomy, the tumor can be removed by excision or enucleation:

Excision is more often used for several lesions, a deep-lying node, or fusion of the cyst with the gonad. Through the incision, the gonad is pulled out from the peritoneum. The area of the ovary where the cyst has developed is excised with a “wedge” and carefully sutured.
Enucleation of an ovarian cyst is carried out only when the benign nature of the formation is confirmed, since with this method the surrounding tissues are not affected. The process has another name – cyst desquamation. The entire capsule is removed, while care is taken to ensure that the cyst does not open and that the exudate does not leak out. Sometimes, to prevent rupture of the capsule walls, pus or exudate is drawn out of it.

If bleeding begins during surgical procedures, the vessel is doped (clamped), then bandaged or cauterized with high-frequency current (diathermocoagulation).

During laparotomy, the surrounding tissues are examined in order to:

detecting the growth of a node into the fallopian tubes, gonads, intestines and bladder tissue;
identifying possible cancer foci and excluding metastases.

In order to determine the nature of the tumor as quickly as possible, a biopsy of the ovarian cyst is necessary, that is, excision of a fragment of the affected tissue, and subsequent histological examination. If the formation turns out to be malignant, treatment is immediately prescribed.

Sometimes, if the doctor is concerned about the type of tissue, a biopsy and oncology analysis (histological examination) are done urgently, right during the operation.

If laparotomy is performed when there is a rupture of the cavity, a purulent process, or hemorrhage, then for 2–3 days the doctor will have to install drainage tubes so that all the fluid with pus and blood is removed from the peritoneal cavity.

How long does the surgical procedure take? The operation is classified as simple and lasts about 45 – 60 minutes.

On what day of the cycle should the operation be performed? To avoid increased bleeding, the node on the gonad should be removed 5–7 days after menstruation.

Types of laparotomy and extent of surgery

How is an ovarian cyst removed and what methods are used? When removing cystic nodes, several surgical techniques are used, which differ in the depth of surgical intervention and the volume of tissue removed.

Which surgical technique the surgeon will choose is determined by the type, size, location, degree of damage to the gonad, the nature of the nodule and the likelihood of cancerous degeneration.

Surgical techniques:

A qualified specialist is always concerned with the question of how to remove a cyst on an ovary, so as to affect as little tissue as possible and not have to cut out the ovary.

Possible complications

Possible consequences of removing an ovarian cyst:

severe pain in the suture area;
formation of adhesions;
postoperative bleeding;
inflammation of tissue in the suture area as a result of infection;
organ damage due to surgeon errors.

Recovery after laparotomy of an ovarian cyst

After removal of the ovarian cyst by laparotomy, the patient will have to stay in the hospital for 7 to 10 days under the supervision of specialists.

Within 30 – 60 days after suture removal:

Any physical exertion and lifting weights exceeding 1 kg are strictly prohibited;
taking a bath, visiting a bathhouse, sauna, swimming pool;
It is necessary to abstain from sexual activity after removal of an ovarian cyst for 2 months.

During this period, it is absolutely necessary to take vitamins. Depending on the type of cyst, as prescribed by the doctor, continue treatment with hormonal drugs and immunomodulators.

Pregnancy after cyst laparotomy

If only a cyst on the ovary or only one sex gland was removed, then a healthy ovary is capable of producing hormones and eggs. Therefore, the probability of conception after surgery for an ovarian cyst remains very high. Reproductive function will finally stabilize after at least 2 to 5 months have passed.

But conception within six months is undesirable, since incomplete restoration of ovarian function can lead to early miscarriage or tissue rupture in the suture area when the uterus enlarges. Therefore, it is advisable to plan a pregnancy no earlier than five to six months after laparotomy of the ovarian cyst.

Without surgery are disclosed in our separate work.