What is ovarian cystectomy?
Ovarian cystectomy is a surgical procedure that is intended to remove one or more cysts from one or both of the ovaries.
Why do I need this surgery?
Ovarian cystectomy may be performed electively or as an emergency operation to remove the cyst. It may also alleviate symptoms, such as pain, if the cyst is thought to be the cause of them. Such pain may occur in the event of a cyst accident; i.e. when the cyst ruptures, bleeds, or when the organ (the ovary) twists upon itself (torsion). Ruptured cysts can result in spillage of their contents, resulting in infection, and adhesions which is the formation of fibrous bands of tissue between organs. If the cyst has caused the ovary to undergo torsion, this is an emergency situation because the supply to the ovary may be disrupted, leading to permanent damage and loss of function.
What does it involve?
An ovarian cystectomy can be performed via a laparoscopy or laparotomy under general anaesthesia.
Laparoscopy is a keyhole surgery in which operating instruments are introduced to the abdominal cavity through small puncture holes that are made. One of the instrument includes a camera to allow for visualisation of the organs.
Laparotomy involves a conventional surgical approach in which a single cut is made in lower abdomen.
Occasionally, there may be a need to convert laparoscopic surgery to laparotomy due to circumstances encountered during the surgery. Such a decision will be made in order that the surgery proceeds safely and this is not considered a complication.
The choice of whether the surgery will be laparoscopy of laparotomy depends on the size of the cyst, the complexity of the anticipated surgery, the nature of the cysts in terms of whether there is suspicion of possible malignancy, patient factors and surgeon expertise. Under the following circumstances, it may be necessary to perform a laparotomy instead of a laparoscopy:
- Technical difficulties in the operation
- Increased risk of complications
- risk of heavy bleeding
- Risk of injury to other organs.
In rare event of an emergency in which there is severe bleeding from the cyst, it may be necessary to remove the whole ovary. Furthermore, in the event of new operative findings such as that of cancer, the uterus, fallopian tubes and/ or both ovaries may have to be removed. in such instance, you will need to give us separate consent for such removal, in order for us to proceed.
What precaution must I take for the surgery?
Please inform your doctor if you have any medical illnesses. Please inform your doctor if any of the following are applicable:
- History of allergy or reaction to any medications, drugs, or food.
- History of bleeding or clotting disorder
- If you are taking blood thinner such as; Warfarin, Aspirin, Ticlopidine or Clopidogrel. These medicines may affect blood clotting and increase risk of bleeding.
What are the risks and complications of the surgery?
The most common complication of an ovarian cystectomy is infection. Although the surgery is performed under strict aseptic conditions to prevent any risk of infection, bacterial invasion occurs to some degree whenever a surgical cut is made. In most instances, through the natural defence mechanism of the body, healing of the affected tissues can occur without difficulty. However, when symptoms such as fever occur, antibiotic medications may be prescribed. On rare occasions, additional surgical measures may be necessary to treat the infection.
Bleeding may occur, and is usually controlled without difficulty. However, blood transfusions and further surgery are needed at times if there is a large amount of blood loss.
- Inadvertent Cyst Rupture Intraoperatively
Intraoperative cyst rupture at laparoscopic ovarian cystectomy occurs more frequently than at laparotomy surgery. The inadvertent spillage of the contents may result in subsequent spread of the conditions to other part of the pelvis. Spillage of cyst may result in irritation to the internal organ causing infection or adhesions. Spillage of malignant cyst may also result in dissemination of the malignant condition to other parts of the pelvis. Thus, when spillage occurs, the affected areas will be irrigated copiously. You will also be given intravenous antibiotics to prevent infection.
- Deep Vein Thrombosis/ Pulmonary Embolism
Deep vein thrombosis is more likely to occur following surgery to the pelvis. It occurs when blood forms clots within the large veins of the leg, and may cause the leg to swell and become warm to touch and painful. If the blood clots break apart, they can travel and lodge in the blood vessels of the lungs, cutting off the blood supply to a portion of the lungs. This is a pulmonary embolism, which is potentially life threatening. There are a number of measures to reduce the risk of deep vein thrombosis, but the most effective of them is for you to move as soon as possible after the operation. Other preventive measures may be taken if appropriate.
- Injury To Other Organs
Because of the closeness of other organs to the area being operated on, there may be a risk of injury to them, particularly the bladder, ureters, and bowels. Bladder injury may lead to the loss of its function, and you may require prolonged catheterization. The ureter, which is the tube connecting the kidney to the bladder is also at risk of being damaged. Depending on the nature of injury, a stent, which is a small hollow tube keeping the ureter open, may be placed to allow the passage of urine. These injuries may not be recognised at the time of surgery and could present later, usually in the first two weeks after surgery. If you have pain, a fever or feel unwell, you must let your doctor know about it.
After any operation, adhesions may form after a period of time. Adhesions are fibrous brands of tissue that form between organs in the abdomen, causing them to stick to one another. The occurrence of adhesions varies, depending on the surgical technique and patient’s characteristics. they may occasionally distort or seal off the fallopian tubes, causing difficulty in conceiving, or cause intestinal obstruction leading to abdominal pain.
- Cyst Recurrence
Even after the ovarian cystectomy has been successfully performed, there is a possibility that new cysts may grow again.
- Reduced Ovarian Reserve
When the cyst is removed, every effort will be made to preserve as much ovarian tissue as possible. Even then, there may be reduced amounts of ovarian tissue left behind after the cystectomy. This may reduce the number of available eggs and may affect future fertility particularly for repeated procedures.
What can I expect after the surgery?
After the surgery, you will be monitored in the observation ward. If you remain well, you will e sent to the normal ward where the monitoring will continue. You will be prescribed painkillers and you may have an indwelling urinary catheter to drain your urine. You will be allowed to drink when you are awake. Your stay in the hospital will vary depending on the nature of your surgery. It may last for 2 days if you undergo a laparoscopy, and 3 to 4 days for a laparotomy.
Upon discharge, you will be given painkillers and an appointment will be made for a follow up consultation at the outpatient clinic 2 to 4 weeks after your operation to review your recovery and the laboratory findings of the nature of the cyst that has been removed.
What are my options?
The alternative to surgical treatment would be for conservative management of the condition by continuing to monitor your wellbeing. If the cyst happens to be malignant, appropriate treatment of the condition may be delayed. If the cyst is benign, not undergoing the ovarian cystectomy would mean that a cyst accident could occur, especially if the cyst continues to grow and reaches a size of more than 5cm.
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