An ovarian cystectomy is a surgical procedure to remove cysts from one or both ovaries while preserving the ovaries themselves. Ovarian cysts are fluid-filled sacs that develop on or inside the ovaries and are common among women of reproductive age. Most ovarian cysts are harmless and go away on their own, but some can cause discomfort, pain, or other complications, necessitating surgical removal. The goal of an ovarian cystectomy is to remove problematic cysts without affecting a woman’s fertility or hormonal balance.

1. What is an Ovarian Cyst?

An ovarian cyst is a sac filled with fluid, semi-solid material, or other tissue that forms on or within an ovary. These cysts are common, especially during the reproductive years, and can be related to the normal menstrual cycle or other medical conditions.

There are two main types of ovarian cysts:

• Functional Cysts: These develop as part of the menstrual cycle and are the most common type. They usually go away without treatment.
• Pathological Cysts: These are less common and may be caused by conditions like endometriosis or polycystic ovary syndrome (PCOS). They can also be non-cancerous or cancerous growths.

2. When is an Ovarian Cystectomy Needed?

Ovarian cystectomy is recommended in the following cases:

• Large Cysts: If the cyst is large (typically over 5 cm), it may not resolve on its own and could cause discomfort or complications.
• Persistent Cysts: Cysts that do not go away after several menstrual cycles or continue to grow.
• Pain or Discomfort: If the cyst is causing severe abdominal pain, bloating, or pressure, surgery may be necessary.
• Risk of Rupture or Torsion: Some cysts can rupture or cause ovarian torsion, a condition where the ovary twists and cuts off its blood supply, leading to severe pain and requiring emergency treatment.
• Uncertainty About Diagnosis: If a cyst appears unusual or could be malignant, a cystectomy may be performed to rule out ovarian cancer.
• Endometriosis-Related Cysts: In cases where endometriosis causes cysts on the ovaries, surgery may be needed to remove them and alleviate symptoms.

3. Types of Ovarian Cystectomy Procedures

The surgical approach to ovarian cystectomy depends on the size and location of the cyst, as well as the patient’s overall health:

• Laparoscopic Ovarian Cystectomy: This is a minimally invasive surgery where the surgeon makes small incisions in the abdomen and uses a laparoscope (a thin tube with a camera) to locate and remove the cyst. Laparoscopic surgery offers a quicker recovery, less pain, and smaller scars compared to traditional surgery. It is the preferred method for smaller cysts.

• Open Ovarian Cystectomy (Laparotomy): In this procedure, a larger incision is made in the abdomen to remove the cyst. This method is used when the cyst is large or there is concern about malignancy. The recovery time is longer compared to laparoscopic surgery.

4. How to Prepare for an Ovarian Cystectomy

Before an ovarian cystectomy, the patient will undergo several tests and evaluations, including:

• Pelvic Ultrasound: This helps determine the size, shape, and location of the cyst.
• Blood Tests: Blood tests, including CA-125, may be performed to check for markers that could indicate cancer, although this is rare.
• Physical Examination: A complete physical examination will be conducted to assess overall health and any potential risks.

Patients will also be advised to follow pre-operative instructions, such as fasting before surgery and stopping certain medications.

5. Benefits of Ovarian Cystectomy

The primary benefits of an ovarian cystectomy include:

• Symptom Relief: Removing the cyst can alleviate symptoms such as pain, bloating, or pressure in the abdomen.
• Fertility Preservation: Unlike an oophorectomy (removal of the entire ovary), a cystectomy preserves the ovary, which is important for women who want to maintain their fertility.
• Reduced Risk of Complications: Removing a problematic cyst can prevent future complications like rupture or torsion.
• Peace of Mind: For women with concerns about cancer or uncertain diagnoses, removing the cyst can provide clarity and reassurance.

6. Risks and Complications of Ovarian Cystectomy

As with any surgery, an ovarian cystectomy carries some risks, including:

• Infection: Any surgery can lead to infections at the incision site or internally.
• Bleeding: There is a risk of excessive bleeding during or after surgery, especially if the cyst is large or located near blood vessels.
• Damage to the Ovary: In rare cases, surgery may inadvertently damage the ovary, affecting fertility or hormone production.
• Recurrence of Cysts: While the cyst is removed, new cysts can still form in the future, especially if the patient has an underlying condition like PCOS or endometriosis.
• Adhesions (Scar Tissue): Scar tissue can form after surgery, potentially causing pelvic pain or fertility issues.

It’s important to discuss these risks with a healthcare provider to determine the best course of action.

7. Recovery After Ovarian Cystectomy

Recovery time depends on the type of surgery performed:

• Laparoscopic Surgery: Most patients can return to normal activities within 1 to 2 weeks. There may be some discomfort and mild pain at the incision sites, but this is typically managed with over-the-counter pain relievers.

• Open Surgery: Recovery from a laparotomy takes longer, typically 4 to 6 weeks. Patients will need to avoid heavy lifting and strenuous activities during this time.

After the procedure, the patient will have follow-up appointments to monitor healing and ensure no complications arise.

8. Ovarian Cystectomy and Fertility

For women who are concerned about their fertility, an ovarian cystectomy is a fertility-sparing option. The surgery aims to remove the cyst while preserving as much healthy ovarian tissue as possible. This allows the ovary to continue functioning, producing eggs and maintaining hormone levels.

In some cases, particularly with large or complex cysts, the surgeon may need to remove part of the ovary. However, as long as one ovary remains intact, a woman can still conceive naturally. Women with concerns about their fertility should discuss this with their surgeon before the procedure to understand the potential impact on reproductive health.