Ovarian Cyst Removal

Ovarian cysts are cysts (fluid-filled sacs) that develop on the ovaries in women. Most cysts are small, painless and don’t cause any symptoms. Symptoms, if any, include pressure, swelling, pain or bloating in the lower abdomen on the side where the cyst is located. If a cyst ruptures, it causes sudden and considerable pain in the abdomen. Rarely, these cysts are cancerous. Cancerous cysts are mostly found in older women after their menopause. Certain conditions such as endometriosis or polycystic ovary syndrome (PCOS) also result in ovarian cysts, but these conditions are very rare and harmless.

Ovarian cyst removal should be performed provided:

•    The cyst is suspected to be cancerous or is cancerous.

•    The cyst is larger than 2.0 inches in diameter.

•    The cyst is causing prolonged symptoms.

There may be some internal bleeding if the cyst ruptures, but it is rare. There may be external bleeding in some severe cases. Such bleeding can be life-threatening, and medical attention should be sought immediately.

Normally, ovarian cysts are painful. There might be some pain in the lower abdomen towards the side of the cyst, but it will be mild. If the pain is severe and/or prolonged, medical attention should be sought.

Ovarian cysts are not hereditary or genetic. However, there is a genetic component to them which means that women with a family history of ovarian cysts are more likely to have these problems.

The most important thing is to talk to the doctor about the course of action if the cyst is found to be cancerous. The doctor will most likely suggest removal of the ovary. Rest all will be a standard procedure like a blood test, urine test, ultrasound, CT scan and other tests as seen fit by the doctor. You need to talk to the doctor about any medications or prescribed drugs that you are taking which may cause any complications. Habits like smoking, drinking which again might cause complications should be abstained from.

If the cyst is large and is causing symptoms or is cancerous, there is no alternative to surgery. Milder forms of cysts can be dealt with by using medications. It is upon the doctor to decide what is best based on your symptoms and medical condition/history. It should be remembered that most ovarian cysts are harmless and resolve on their own.

Ovarian cyst removal can be done in two ways-

•    Laparoscopy – It is performed if the cyst is smaller and uses a laparoscope (small, tube-like a microscope and a light attached to it) to find the cyst and remove it through small incisions made in the abdomen. The incisions are then closed using dissolvable stitches. It has a recovery period of about two weeks. Patients are generally discharged on the same day.

•    Laparotomy – It is performed if the cyst is bigger and/or is cancerous and the ovaries have to be removed as well. A single, larger cut is made in the abdomen to get access to the ovary and then is closed with staples or stitches. The recovery period is six to eight weeks. Patients are required to stay in the hospital for at least a couple of days.

Both types of surgeries are done under general anaesthesia and can take 1-2 hours to complete

You will be required to stay in the hospital for two days in case of a laparotomy. You can return home on the same day in case of a laparoscopy. You will be given IV fluids and medications during this recovery period. The recovery period is two weeks for a laparoscopy and six to eight weeks for a laparotomy. You are required to not put stress on the wounds during the recovery period.

Ovarian cysts can cause infertility in the following cases –

•    The cysts are because of endometriosis. Endometriosis is a condition in which the tissue lining your uterus grows outside of the uterus.

•    The cysts are because of Polycystic Ovary Syndrome (PCOS). It is condition marked by irregular periods, numerous small cysts on your ovaries, and higher levels of hormones. It is associated with irregular ovulation which might cause infertility

•    The cysts become infected causing pelvic infection which may cause scarring of the fallopian tubes and lead to infertility.

Ovarian cysts are generally not cancerous. The chances of them being cancerous are more if the cysts are found in a woman after her menopause. 

If symptoms synonymous with ovarian cysts are observed, your doctor may recommend the following tests

•    Ultrasound or CT scan

•    CA-125 blood (in case of cancerous cysts)

•    Pregnancy test (they can also reveal corpus luteum cysts)

Recovery after an ovarian cyst removal is pretty normal. Recovery period of a laparoscopy is two weeks and of a laparotomy is six to eight weeks. You should not do any physical activities that put a strain on the wounds for the recovery period. You might be given medications and some dietary instructions. Some post-op tests are generally done to check for any complications or recurrence of the cysts.

Side effects of ovarian cyst removal include-

•    Discomfort in the lower abdomen area

•    Vaginal bleeding or discharge for up to 48 hours

•    Tiredness

•    Pain in your shoulders

•    Infertility (if the cyst is cancerous and the ovaries are removed)

Complications of ovarian cyst removal include

•    Recurrence of cysts

•    Need for removal of ovaries

•    Infection at the site of surgery

•    Excessive bleeding (Haemorrhage)

•    Blood clots

•    Damage to other organs 

The cost of ovarian cyst removal surgery in India varies across different cities and hospitals.

Ovarian cysts are fluid-filled sacs or pockets that may be formed in an ovary or the surface of the ovary.

An ovary is an oval-shaped, female reproductive organ in which eggs or ova are produced. The ovaries are usually two in number, one on either side of the female uterus (womb).

A surgical procedure performed to remove a cyst or multiple cysts that may be present in the ovary or the surface of the ovary is known as ovarian cyst removal surgery.
A small ovarian cyst may present no problems and may even get treated on its own. However, a large ovarian cyst or an ovarian cyst that is likely to rupture may cause complications and require surgical removal.

The different types of ovarian cysts may include:

1. Functional ovarian cysts: These cysts are associated with the menstrual cycle of a woman and are of the following types:
2. Follicular cysts: During the menstrual cycle of a woman an egg or ova grows inside a sac, known as a follicle, which is present inside the ovaries. This follicle normally breaks open to release an egg. But if the follicle does not break open, the fluid inside the follicle can cause a follicular cyst formation.
3. Corpus luteum cysts: The follicle will usually dissolve after releasing an egg. But if the follicle fails to dissolve and the follicle opening seals, the additional fluid gets accumulated inside the sac forming a corpus luteum cyst.
4. Non-functional ovarian cysts: These cysts are not associated with the menstrual cycle of a woman and are of the following types:
5. Dermoid cysts: They are sac-like growths in the ovaries which contain hair, fat, and other tissue.
6. Endometriomas: The tissues that normally grow inside the uterus start forming outside the uterus and get attached to the ovaries, resulting in the formation of a cyst.
7. Cystadenomas: They are non-cancerous growths that usually develop on the outer surface of the ovaries.
8. Multiple small cysts: In polycystic ovary syndrome, the ovaries may contain many small cysts. This can lead to the enlargement of the ovaries. These cysts can cause infertility if left untreated.

Ovarian cyst has an increased chance of developing in the following cases:

• Hormonal disorders
• Pregnancy
• Pelvic infection (infection of the reproductive organs)
• History of an ovarian cyst
• Endometriosis (when the endometrial cells grow outside the uterus instead of growing inside it)

The symptoms of ovarian cysts are:

• Abdominal (stomach) bloating
• Painful bowel movements
• Painful sexual intercourse
• Pelvic pain that occurs before or during the menstrual cycle
• Pain in the thighs or lower back
• Tenderness of the breast
• Nausea
• Vomiting
• Contact your doctor immediately if you have the following symptoms:
• Fever
• Sharp, severe pelvic pain
• Rapid breathing
• Dizziness
• Faintness 

The complications associated with an ovarian cyst may include:

• Ovarian torsion (twisting and moving of the ovary)
• Ruptured cyst causing severe pain and bleeding
• Abscess formation (infected ovarian cyst causing pus formation)

An ovarian cyst removal surgery is required in the following cases:
Ovarian masses or growths are present in both the ovaries
Ovarian cyst that does not get smaller in size or disappear after watchful waiting for 2 to 3 months
Ultrasound examination (sound waves are used to obtain clear images of the female reproductive organs) confirms that the cyst is not a simple functional cyst
Suspected case of ovarian cancer

In case of ovarian growth in:
A young girl who has never had her menstrual period
A woman who has had her menopause (post-menopausal woman)
A woman who is using birth control pills

Pelvic exam: A doctor inserts one or two lubricated, gloved fingers into the patient’s vagina to check a woman’s internal reproductive organs, including the ovaries.
Ultrasound: Sound waves are used in this test to check the location, shape, size, and composition of an ovarian cyst.
CT scans and MRI scans: These are imaging tests done to obtain clear pictures of the internal female reproductive organs.
Pregnancy test: This test is done to rule out pregnancy.
CA-125 blood test: An increase in the cancer antigen 125 (CA 125) protein level in blood may indicate endometriosis, ovarian cancer, pelvic inflammatory disease (an infection of the female reproductive organs), and uterine fibroids (non-cancerous growths in the womb of a woman). 

The following preparation may be required before an Ovarian Cyst Removal Surgery: 
Tell the doctor if you have any medical disorders.
Tell the doctor if you are on any medications, supplements, or herbs
Tell the doctor if you have any allergies.
The doctor will tell you which medicines you can or cannot have before the procedure.
You will most likely be told to stop taking blood-thinning medications like warfarin and aspirin a few days before the procedure.
Quit smoking at least two weeks before the procedure.
Do not eat or drink anything eight hours before the surgery.
The medicines that need to be taken before the surgery can be taken with small sips of water.

Many ovarian cysts disappear on their own. The following treatments are recommended in the case of ovarian cysts that do not go away on their own:
1. Medications:
In the case of ovarian cysts which recur, the doctor prescribes birth control pills to stop ovulation and prevention of the development of new cysts.
These medications also reduce the chances of ovarian cancer development.
2. Surgery:
In the case of an ovarian cyst that does not dissolve on its own or grows larger in size, the following ovarian cyst removal surgeries may be performed:

Laparoscopy:
The surgeon makes a small cut or incision above or below the belly button.
A small device with a camera on one end, called a laparoscope, is inserted by the surgeon through the incision.
The laparoscope helps the surgeon in viewing the pelvic cavity and reproductive organs.
A small surgical instrument is then inserted into the abdomen to remove the cyst.

Laparotomy:
In the case of a large cyst, the doctor a large incision is made in the abdomen to remove the cyst.
An immediate biopsy is performed, where the excised cyst tissue is sent to the laboratory to check if the cyst is cancerous.
The surgeon may perform a hysterectomy to remove the woman’s uterus and ovaries if the cyst is found to be cancerous.
An ovarian cyst removal surgery may take one to two hours to complete.

Most patients can go home on the same day of the laparoscopy procedure.
In laparotomy cases, a two to four days stay in the hospital may be required.
It is normal to have some soreness around the surgical site for one or two days after the surgery.
The laparoscopy procedure has a quick recovery and the patient normally resumes daily activities within a week of the procedure.
A laparotomy procedure has a longer recovery time and the patient normally returns to normal activities only after 12 weeks.
Avoid heavy lifting for the first few weeks after the procedure.
Avoid sexual intercourse till your doctor permits you for the same.

The side effects associated with an ovarian cyst removal surgery include:
Infection
Bleeding
Blood clot formation
Allergic reaction to anesthesia
Damage to the other organs
Need to remove one or both the ovaries
Recurrence of ovarian cyst after removal
Infertility

The cost of ovarian cyst removal surgery varies depending on the type of procedure done, the severity of the condition, and the overall health of the patient. 

The cost also varies amongst different hospitals and doctors. The cost is generally between INR 1,19,000 to INR 1,95,000.