How is a cyst removed? Ovarian cyst: sizes for surgery are dangerous and normal

An ovarian cyst is a benign noncancerous lesion requiring surgical treatment. The most efficient method surgical intervention in this case, there will be laparoscopy - a delicate operation, accompanied by minimal trauma to the abdominal cavity and allowing not to affect the functionality of the ovary.

Laparoscopy is used to treat follicular neoplasms corpus luteum. In the vast majority of cases, doctors manage to save the organ and not affect its functionality: after removing the cyst, women retain the ability to conceive and bear a fetus.

Indications

One of the most common diseases of modern gynecology - an endometrioid ovarian cyst (a hollow formation ranging in size from 1.5 to 10 cm, inside which there is an old, coagulated brown blood) - requires medical diagnostics and surgical treatment. Accordingly, than used to be a woman turns to a specialist, the less damage to the body, in particular, reproductive function, will be inflicted.

It is planned to be examined by a specialist for women with a genetic predisposition to follicular formations. The cyst begins its development when menstrual blood enters the uterine pelvic cavity through the tubes: the cells of the inner surface of the uterus (endometrium) attach to various organs, including the ovaries, where they develop under the influence of progesterone and estrogen, causing regular inflammatory processes. Biochemical processes occurring during inflammation often lead to infertility.

Testing may be needed if you have the following symptoms:

• pelvic pain before and during menstruation;
• significant discomfort during intercourse;
• pain when urinating.

Since the disease is often asymptomatic, and the cyst may not bother you for many years, it will help to eliminate the risk of its development. scheduled inspection at the gynecologist.

In most cases, the ovarian cyst is removed in a planned manner, however, endometrioid and other formations in the corpus luteum have a risk of rupture of the cyst capsule or malnutrition. In the presence of such factors, the operation is prescribed in urgent order and may be accompanied by removal of the appendage (pipe and ovary on the affected side).

List of diseases

Removal of an ovarian cyst is effective in the fight against the following diseases:

• formation in the ovary (follicular, tumor), not amenable to regression within three months (on its own or under the influence of hormonal agents);
• formations that appeared during menopause;
• "twisted" leg of the cyst; rupture of the follicle, suppuration, hemorrhage;
• suspicion of malignancy in the tissues of the ovary.

Training

Before an operation to remove an ovarian cyst is scheduled, a gynecologist performs a diagnosis, which includes the following steps:

• collection of anamnesis;
• manual inspection;
• Ultrasound of the pelvic organs, carried out in at least two menstrual cycles;
• colposcopy;
• fluorography;
• flora research;
• blood tests - biochemical, clinical, histological (ROMA index, CA-125), to determine the Rh factor, blood group and coagulation, for HIV and RW;
• MRI of the pelvic organs (may be required for a more accurate diagnosis).

One of the contraindications for laparoscopy may be overweight, therefore, before the operation, the doctor may prescribe a special diet and a set of exercises to normalize the body mass index.

Immediately before the operation, you must take a bath, remove hair from the abdomen and external genitalia. The last meal - until 19:00, drinking - at 22:00. Before the operation, it is necessary to clean the intestines with an enema - this will greatly simplify the surgical intervention, increase the range of instruments for laparoscopy and the radius of view.

How is the procedure

• diagnostic laparoscopy (to confirm the diagnosis);
• therapeutic laparoscopy (to eliminate the cyst);
• control laparoscopy (to check the condition of the organ after treatment).

Laparoscopy of a cyst with preservation of the ovary:

• the operation is performed under general anesthesia;
• for more convenience in abdominal cavity carbon dioxide is injected, which raises the wall in such a way as to open the doctor to a maximum view of the organs;
• during laparoscopy, small incisions are made on the skin of the abdomen (anterior abdominal wall), not more than 1.5 cm in size (up to 4 incisions);
• through them, trocars are inserted into the walls of the cavity to install the camera and instruments;
• the cyst follicle is isolated within healthy tissues, producing a thorough hemostasis of the formation bed, then several internal sutures subject to resorption are applied to the cyst site;
• the cyst is placed in a plastic container and removed through one of the incisions, then transferred to the laboratory for histological examination.

Ovarian resection

If a tumor, polycystic or cancer is found on the ovary, an ovarian resection is prescribed. The operation is prescribed only as a last resort, and often doctors try to use minimally invasive methods to treat ovarian cysts.

Postoperative period

On the first day after the operation, the doctor prescribes painkillers. If necessary, the doctor may additionally prescribe a course of antibiotics. Getting out of bed is allowed 3-5 hours after laparoscopy. Discharge from the hospital occurs within two days in the absence of complications. Removal of sutures is scheduled 6-7 days after the operation. Until the start of the next menstruation, a woman is not recommended to lift weights, experience significant physical exertion and conduct sexual life. The scars from the operation disappear in a short time and become invisible. During the first day after recovery from anesthesia, patients may experience pain, which is relieved by anesthetics.

Nutrition

After laparoscopy, the doctor may prescribe a special diet that excludes alcoholic drinks and heavy food. In the first days after surgery, experts recommend eating broths, dairy products, cereals, up to 1.5 liters of water per day and sticking to fractional nutrition(eat food in small portions, dividing it into 5-6 meals).

Possible Complications

The following symptoms may indicate an infection:

• increased body temperature;
• lower abdominal pain;
• dark highlights.

Most often, complications occur due to factors:

• obesity;
• taking certain types of medications;
• alcohol and tobacco use;
• pregnancy.

At the first symptoms of malaise after the operation, it is necessary to immediately consult a doctor for ultrasound and detailed diagnostics, the results of which will prescribe a second treatment.

Pregnancy after laparoscopy

Many women worry about the possibility of pregnancy after laparoscopy. Modern technologies minimally invasive surgical treatment allows you to maintain reproductive ability even after removal of a formation of significant size.

A woman should plan to conceive no earlier than 2-6 months after the operation. It is also necessary to regularly visit the attending physician to monitor the condition. It is possible to observe in a hospital for a detailed examination. To maintain health and prevent the recurrence of formations in the ovary, the doctor may prescribe medication, targeted balancing hormonal background.

In the postoperative period, pregnancy may not occur due to the preservation of the focus of the disease. In this situation, a second laparoscopy is prescribed to finally remove the cyst and complete the treatment.

aMain indications for surgery to remove

1. The possibility of an oncological process.

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

3. Neoplasm arose after the onset of menopause.

4. Hemorrhages into the cyst.

5. Rupture of the cyst wall.

6. "Twisting" of the cyst legs.

7. Purulent processes that began in the cavity of the cyst.

We conduct a thorough diagnosis to make a decision on the treatment of ovarian cysts

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Malignant tumor or ovarian cyst?

The doctor thinks about removing even a small cyst no larger than 10 mm if, as a result of research, signs are found that speak in favor of the oncological process. For cancerous tumor characterized by large parietal seals and pathological blood flow. However, errors in ultrasound examination are not excluded. For example, if the cavity of the cyst is filled with blood, the echographic image will match the tumor.

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

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

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

Already after the operation, it is possible to accurately establish its nature when considering cellular structure under a microscope. If suspicions about the tumor are confirmed, the specialist will prescribe additional research and specific treatment to avoid relapse.

Cyst complications requiring surgery

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

If conservative therapy is ineffective for several months, the cyst is removed promptly. All cysts that formed during the menopause are also subject to surgical removal, since there is a high probability of their degeneration into a malignant tumor.

One of the most common complications is "torsion" of the cyst legs, which is accompanied by a violation of blood circulation in it. It occurs due to a sharp change in body position, excessive physical activity, severe straining or chronic cough. With partial "torsion", blood continues to flow into the cyst, but its outflow is difficult, so edema occurs. This condition may be accompanied by unilateral It's a dull pain in the lower abdomen, because due to the increase in the size of the cyst, the pressure inside the ovary increases.

Full "torsion" of the legs is accompanied by a violation of the blood supply to the cyst, so necrotic processes begin in it. The situation is aggravated if the woman had chronic infectious diseases reproductive system. Under such conditions, the likelihood of infection of the cyst and the development of purulent inflammation. In the future, it may cause life threatening conditions - peritonitis. To prevent this, doctors remove the ovarian cyst in case of "torsion" of its legs.

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

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

Our specialists

Ovarian cyst is one of the most common pathologies in patients of reproductive age. Almost every third woman sooner or later goes to the doctor with a complaint about the mass formation of the appendages. Some cysts are functional and disappear on their own within 2-3 months, others require mandatory surgical treatment. AT last case Only a timely operation allows you to get rid of the problem and avoid the development of complications.

Removal of an ovarian cyst is carried out in several ways: the doctor can only remove the pathological formation by exfoliating it within healthy tissues, resect the ovary, or remove the entire organ. The choice of operation method is determined by the type and size of the cyst. The sooner a woman applies for medical care, the more the doctor will have the opportunity to save the ovary and not interfere with the patient's reproductive plans.

Let us consider in more detail what operations are performed with an ovarian cyst and what affects the choice of a particular method.

Is surgery always necessary and is there an alternative?

Operation is not the only way cope with the disease. Often, you can get rid of the cyst in other ways:

• hormone therapy. For the regression of the pathological focus, gestagens and combined oral contraceptives. The effect is expected after a month, and it comes after the next menstruation. The course of treatment can last up to 3 months;
• Physiotherapy. Means are used that stimulate blood flow in the pelvic organs and promote the resorption of the cyst.

Surgical removal of an ovarian cyst usually occurs after poor treatment with conservative methods.

All of the above is true only for functional cysts - follicular or luteal. Such formations are prone to spontaneous disappearance even without drug treatment, so doctors in similar cases don't rush into surgery. Often, after 3 months of observation, the focus resolves, and no further therapy is required. If the cyst has not gone in due time, its removal is indicated.

On a note

There are attempts to treat the pathology of the appendages with the help of leeches, acupuncture, medicinal herbs, but their effectiveness has not been proven. The use of such means is possible, but alternative treatment should not go against the doctor's prescriptions and even more so replace them.

Somewhat apart are endometrioid cysts. This pathology lends itself well hormone therapy, and in its treatment in many cases it is also possible to do without surgery. Not only COCs and gestagens are used, but also more strong means- Gonadotropin-releasing hormone agonists and progesterone receptor modulators. The course of treatment can last up to 6 months.

Various types of ovarian cysts.

Indications for surgical treatment

An ovarian cyst in women is removed in such situations:

• No effect from conservative therapy functional and endometrioid formations;
• Identification of organic cysts that are not prone to regression - dermoid, paraovarian, serous;
• Suspicion of malignant degeneration of the tumor;
• The development of life-threatening complications: suppuration of the cyst, rupture of its capsule with hemorrhage or torsion of a thin leg;
• Detection of cysts in menopause.

Surgery for ovarian pathology is carried out in a planned manner. The doctor prescribes full examination, during which it is possible to clarify the type of formation and identify concomitant diseases. After preparation, the day of the operation is determined. But if the cyst burst or twisted, the patient is operated on urgently.

Schematic representation of ovarian cyst torsion requiring emergency surgery.

Contraindications for the operation

There are no absolute contraindications for surgery. If the cyst needs to be removed, the doctor will perform all the necessary manipulations. The operation can only be delayed in certain situations:

• Acute infection: influenza, intestinal infection, diseases respiratory tract and etc.;
• Exacerbation of chronic pathology;
• Neuropsychiatric disorders;
• Skin diseases in the area of ​​the incision.

Surgical treatment is carried out after recovery or stabilization of the woman's condition.

Removal of an ovarian cyst during pregnancy

Special attention should be given to surgical intervention during pregnancy. If the identified formation does not hurt and does not bother, the operation is performed after childbirth. During gestation, removal of a cyst is possible only in such situations:

• Rupture of the cyst capsule, hemorrhage in the ovary and abdominal cavity;
• Torsion of the legs of education;
• Inflammation of the ovaries against the background of the pathological focus;
• Revealing malignant tumor;
• The rapid growth of the formation, leading to compression of the pelvic organs and interfering with the development of the fetus.

A planned operation is performed at a period of 16-20 weeks of pregnancy, an emergency operation is performed immediately after the pathology is detected. You can not hesitate in the development of complications, deterioration of the condition of the woman and the fetus. In other cases, it is better to wait for a convenient time - the second trimester. During this period, the internal organs of the fetus have already formed, the placenta has begun its work, and the risk of abortion after surgery is minimal.

A pregnant woman with an ovarian cyst requires more careful monitoring.

In late pregnancy, in the presence of emergency indications, surgical intervention can be carried out in two stages. Runs first cesarean section and the fetus is removed, then the cyst is removed. The issue of timing and choice of treatment method is decided individually for each patient.

How to understand that an operation is needed?

When a pathology of the left or right ovary is detected, it is necessary to determine the type of formation and find out if there are indications for surgical intervention. To do this, a woman must undergo a complete examination, which includes:

• Blood test for tumor markers CA-125, CA 19-9, HE4. An increase in the level of these indicators speaks in favor of a malignant tumor and requires careful differential diagnosis. In modern gynecology, to clarify the type of formation, the definition of the ROMA index is used;
• Ultrasound procedure. On ultrasound, benign cysts are usually hypoechoic, single-chamber, without inclusions (except for the dermoid). In cancer, the appearance of a large number of chambers, as well as pathological inclusions, is noted;
• Doppler. Identification of atypical blood flow indicates a probable malignant tumor;
• Magnetic resonance imaging. MRI allows you to see structures that are invisible on ultrasound and clarify the type of formation.

If these methods do not allow a diagnosis, diagnostic laparoscopy is performed. During the operation, the doctor may find additional symptoms indicating ovarian cancer (peritoneal carcinomatosis, changes in lymph nodes). Endoscopic intervention also helps to distinguish an ovarian cyst from salpingo-oophoritis, ectopic pregnancy and other pathologies.

This is what an ovarian cyst looks like with a diagnostic laparoscopy.

Preparation for surgical treatment

After receiving a referral for surgery, a woman must undergo an examination, which includes:

• Blood tests: general clinical, biochemical, clotting;
• Determination of the Rh factor and blood group;
• Check for dangerous infections: syphilis, viral hepatitis, HIV;
• Tests for tumor markers;
• General urine analysis;
• Plain swab for flora and oncocytology;
• Colposcopy - examination of the cervix;
• Ultrasound of the small pelvis;
• Consultation with a gynecologist, therapist and other specialists according to indications.

All tests must be completed within two weeks. Preparation for surgery should not take long time. Some blood and urine tests are only good for a month.

Women over 40 years of age are additionally assigned the following studies:

• Aspiration biopsy of the endometrium;
• Colonoscopy - endoscopy large intestine;
• Mammography.

All these tests make it possible to differentiate a primary ovarian tumor from metastases from the intestines, breast, and uterus. The likelihood of developing this pathology increases in the premenopausal period and in menopause.

At comorbidities uterus, the doctor may prescribe hysteroscopy with curettage of the organ cavity. The received material is sent to histological examination. In this case, additionally take aspiration biopsy endometrium is not needed.

When tumors of other organs are detected, the treatment tactics change and the woman is referred for a consultation with an oncologist.

It is important to know

In medicine, cases of family cancer of the ovaries, uterus, mammary glands and intestines are known. If there were such stories in the family of a woman with an appendage cyst, she should be especially careful about her health and not delay with surgical treatment.

Surgical intervention for ovarian diseases in women of reproductive age is planned for the 5-7th day of the cycle. During menstruation, the operation is not performed. If the menstruation lasts more than 7 days, you need to wait until it ends. In menopause, surgery can be performed at any time.

The day of the menstrual cycle is important for the operation, since depending on the phase of the cycle, the hormonal background changes.

Anesthesia during surgery: what is useful to know

Removal of an ovarian cyst is a complex operation and is performed under general anesthesia. The patient falls asleep and wakes up only after the completion of all manipulations. During the surgery, she does not feel anything. He does not feel how an incision or puncture of the skin is being made, he does not see how the surgeon penetrates the pelvic cavity, finds the ovary and excised the cyst, does not observe the suturing of the wound and learns about the completed operation after the fact. This approach allows the doctor to calmly perform all the manipulations, and the woman - not to experience unbearable pain.

Surprisingly, many women are afraid not so much of the operation as of general anesthesia. They feel an understandable fear of the unknown and ask the anesthesiologist questions that concern them:

How long will the anesthesia last?

The duration of general anesthesia depends on the time of the operation. The gynecologist begins work immediately after the instructions of the anesthesiologist - a doctor who gives anesthesia and monitors the patient's condition. After suturing and treating the wound, the woman is immediately removed from anesthesia and soon regains consciousness. On average, an operation to remove an ovarian cyst lasts from 40 minutes to 2 hours.

Does it hurt during anesthesia?

No, with general anesthesia, the woman does not feel anything.

Is it possible to wake up during the operation, feel unbearable pain and die of shock?

In modern anesthesiology, such situations are excluded. Proper selection of drugs for anesthesia allows you to reliably turn off consciousness and fully control the process.

Can there be complications from anesthesia? Suddenly, the heart, liver or kidneys will not withstand?

Such situations happen, but an experienced anesthesiologist knows exactly what to do in this case and what to do to save the patient's life. Competent preparation for surgery and anesthesia allows you to reduce possible risks to a minimum.

It is important to know

On the eve of the operation, the patient is examined by an anesthesiologist. It is necessary to inform the doctor about all existing diseases and allergies to drugs. Only in this way the doctor will be able to choose the most safe anesthesia.

Consultation with an anesthesiologist is necessary for the correct selection of the method of anesthesia in a particular case, taking into account all the characteristics of the patient.

Coming out of anesthesia is always stressful for the body. In the first hours there is some confusion, drowsiness and lethargy, disorientation in space. There may be a moderate headache, dizziness. According to reviews, many women complain of nausea, vomiting is not excluded. All these are regular situations that occur even after very good drugs. Within a few hours, the condition should improve. In a different situation, symptomatic therapy will be prescribed.

After the completion of the action of anesthesia, the appearance of pain in the postoperative wound is noted. All discomfort in this case, they are successfully stopped by potent analgesics. According to women, after laparoscopy, the pain is not so strong and lasts much less than with laparotomy. After abdominal surgery, more time is required to recover.

Methods for removing an ovarian cyst

First of all, the doctor determines the surgical access. There are two ways to excise an ovarian cyst:

• Laparotomy, or abdominal surgery. This is a classic option, involving an incision in the skin and underlying tissues. Requires a long recovery after surgery, often accompanied by complications. In modern gynecology, it is used if endoscopic intervention is not possible (with giant cysts, a pronounced adhesive process, a malignant tumor, etc.);
• Laparoscopy is a minimally invasive, gentle operation. The doctor performs all manipulations through small punctures. Gas is injected into the abdominal cavity, which creates free space for the operation. The doctor sees all his actions on the screen. Recovery after laparoscopy is faster, complications occur less frequently.

The choice of access is determined by the indications for treatment, the size of the cyst, the presence of concomitant pathology and the technical equipment of the clinic. If the hospital does not have equipment and doctors who know the technique of minimally invasive endoscopic intervention, abdominal surgery becomes the only treatment option.

Types of surgical intervention:

Cystectomy

The exfoliation of a cyst within healthy tissue is called a cystectomy (cystectomy). During the operation, the doctor cuts out only the formation, while the ovary remains in place. The incision area is carefully coagulated. In cystectomy, it is important to preserve the ovarian cortex and primary follicles. If this zone is damaged, ovulation will not occur in the ovary and it will lose its function.

Performing laparoscopic cystectomy.

Cystectomy is performed only with a uniquely benign nature of the formation. To clarify the diagnosis, the removed material is sent for urgent histological examination. The answer comes after 10-20 minutes. If the tumor turns out to be malignant, the scope of surgical intervention expands.

On a note

Urgent histological examination has one significant drawback - it is not very accurate. There are diagnostic errors that lead to serious consequences. Therefore, when determining the volume of the operation, the doctor focuses not only on the analysis data, but also on the results of ultrasound and MRI.

Laser removal of an ovarian cyst is an alternative to the traditional scalpel. The tissue incision is made with an instrument that precisely emits a laser beam. Otherwise, the course of the operation does not differ significantly from conventional surgery. Laser cystectomy allows to reduce the volume of blood loss, since immediately after tissue dissection, their coagulation (cauterization) is carried out.

The photo shows the stages of removal of an ovarian cyst:

Ovarian resection

Cutting out a cyst along with a part of the ovary is carried out with a large size of the formation, when it is impossible to excise the tumor without damaging the surrounding tissues. It is recommended for relapse of the disease, when the pathological formation reappears in the same ovary. During this operation, the doctor also tries to preserve the cortical layer of the ovary and not touch the primary follicles.

On a note

If a resection of the ovary is planned (especially on both sides) in a young woman, it is recommended to take the eggs in advance and freeze them. Such eggs can be stored in a cryobank for several years. If, after the operation, the ovarian reserve decreases and the woman cannot become pregnant on her own, she will still have a chance to conceive a child through IVF using her frozen eggs.

Stages of ovarian resection.

Ovariectomy

Removal of the ovary along with the cyst is performed in such situations:

• A large mass that displaces normal ovarian tissue. At the same time, it will not be possible to restore the organ after the operation and its removal is shown;
• Ovarian cyst in menopause. In this case, leaving the organ does not make sense. The ovary no longer functions, and the cyst is very likely to be a malignant tumor.

According to the indications, the volume of the operation can be extended to the removal of the ovary along with the fallopian tube. In malignant processes, the uterus, omentum, peritoneal sheets can be removed.

At the slightest suspicion of malignancy during the operation, it is recommended to use special protective containers. The cyst, together with the ovary, is placed in a container, and the contents of the tumor do not go beyond the outlined boundaries. Even if the tumor bursts during manipulation, its cells will not leave the container and the cancer will not spread.

Removal and removal of a malignant cyst occurs in a special container.

The cost of an operation to remove an ovarian cyst depends on the method chosen:

• Laparoscopic cystectomy in Moscow clinics will cost from 20 to 45 thousand rubles;
• The price of abdominal surgery starts from 30 thousand rubles.

By compulsory medical insurance policy surgical intervention is performed free of charge if there are indications and the possibilities of the clinic.

Follow-up in the postoperative period

After abdominal surgery, a scar remains on the skin above the womb, after laparoscopy - a few small traces of incisions (2-8 mm). Seams are processed daily using antiseptics. If the stitches are non-removable, they do not need to be removed - they will dissolve on their own on the 7-10th day after they are applied. Otherwise, the sutures are removed before discharge from the hospital.

On the first day after the operation, the woman begins to get up and walk around the ward. Early rise is considered a good prevention of the formation of adhesions and prevents the development of complications.

Nutrition after the operation is sparing. It is recommended to take only boiled and baked foods and to give up fried foods for a while. On the first day, only liquid soups are allowed. Then the patient gradually returns to the usual diet.

Discharge from the hospital occurs on the 3-5th day after laparoscopy and on the 7-10th day after abdominal surgery. For a complete recovery of the patient's ability to work after surgery, 14-28 days should pass.

Depending on scale surgical intervention The length of stay in the hospital will also vary.

• Sexual rest for 2-4 weeks;
• Limitation of physical activity;
• The ban on visiting saunas, baths, swimming pools.

Control ultrasound is performed 1, 3 and 6 months after the operation. In case of recurrence, additional examination and treatment is indicated. The scope of the surgical intervention reoperation can be expanded.

You can plan pregnancy 6 months after the operation. Before conceiving a child, it is recommended to take oral contraceptives. These funds will not only protect you from unwanted pregnancy, but also help restore hormonal levels after surgery.

Complications after surgery

An operation to remove an ovarian cyst can lead to undesirable consequences:

• Intra-abdominal bleeding. Occurs when a cyst ruptures and significant tissue damage occurs. The integrity of the ovary is restored during the operation;
• Infection. It develops against the background of concomitant inflammatory pathology of the pelvic organs. It is accompanied by an increase in body temperature and increased pain in the postoperative period. Appointment shown antibacterial drugs, according to indications - repeated operation;
• Soldering process. Occurs more often after abdominal surgery with significant tissue injury. It threatens with infertility and miscarriage.

Surgery to remove an ovarian cyst is not the easiest procedure, and the likelihood of complications during and after it is not zero. And yet, if there are indications, it is not worth refusing surgical intervention. A timely operation is a chance to preserve reproductive health, and in some cases life. Do not let the problem take its course - the consequences can be unpredictable.

An interesting video about ovarian cysts and their surgical treatment

About the endometrioid cyst and its surgical treatment

Ovarian cysts are found in many women. Often they reach large sizes, while various complications appear. Some of them are not particularly dangerous, they can resolve on their own over time. Other similar neoplasms are a serious threat to health, causing infertility. When choosing a method for eliminating cystic cavities different kind possible complications are taken into account. In case of real danger, remove surgical method. If possible, try to carry out the operation in a gentle way.

Content:

Why is a cyst removed?

Cysts are benign neoplasms that can change the structure of these organs, disrupt the functioning. The causes of their occurrence may be hormonal disruptions in the body, diseases and injuries of the genital organs, genetic disorders or congenital pathologies reproductive health.

Enlargement of ovarian cysts leads to complications varying degrees gravity. Among them - suppuration of the contents, as well as rupture of the tumor membrane, leading to peritonitis, internal bleeding. Twisting of the leg and the occurrence of necrosis are possible. Often, the formation of a cyst becomes the cause of infertility. Adhesions appear around it, disrupting the work of neighboring organs. Some types of such neoplasms can degenerate into malignant tumors.

There are so-called "functional" cysts that are capable of self-resorption (follicular and luteal). They are formed due to a temporary hormonal failure that occurs during the course of the processes of the menstrual cycle. As soon as the violation disappears, the reverse development of neoplasms begins.

All other types of ovarian cysts require removal, as they are able to grow, and the consequences of their development are unpredictable.

Note: Such complications during pregnancy are especially dangerous. Doctors advise to complete gynecological examination even during its planning period, to get rid of neoplasms in advance.

Cysts of this type include endometrioid, dermoid, paraovarian. In addition, there are still cyst-like tumors of the ovaries (teratomas, fibromas, cystadenomas). Drug treatment will not stop their growth and will not prevent the consequences. The only way to get rid of them is through surgery.

Indications for removal of cystic neoplasms

Removal of an ovarian cyst is indicated in the following cases:

• there is a noticeable increase in the cystic capsule, which does not stop after 3 months, its diameter exceeds 3 cm;
• there are doubts about the nature of the neoplasm;
• the cyst has a long stalk that can twist;
• due to an increase in the cyst, the woman developed abdominal pain;
• there are signs of a malfunction of the bladder or intestines, squeezed by a growing ovarian cyst.

If a woman is admitted to the hospital with symptoms of complications such as tumor rupture, pedicle torsion, ovarian apoplexy, abdominal hemorrhage, the operation is performed immediately. These symptoms include sudden onset of severe abdominal pain, bloating, fever, fainting.

Types of operations to remove cysts

When choosing a method surgical removal ovarian cyst is taken into account its size, type, severity of complications. The age of the patient is also taken into account. When possible, in the treatment of women young age the operation is carried out in the most gentle way in order to preserve the functionality of the ovaries. There are several types surgical intervention.

cystectomy- exfoliation of the neoplasm with the preservation of the ovary itself. After such an operation, the woman retains the ability to bear children. This method removes small cysts (up to 3-5 cm in diameter), which are benign.

wedge resection. The cystic capsule is removed along with part of the ovarian tissue. This operation is more traumatic. It is produced if the cyst has a wide base, grows together with the tissues of the ovary.

Ovariectomy – complete removal ovary. The operation is performed with ovarian apoplexy, torsion and suppuration of the cyst, which creates a threat of peritonitis.

Adnexectomy- removal of the ovaries and fallopian tubes. Produced if the onset of a malignant process is confirmed.

presence in the tumor cancer cells determined by ovarian biopsy. In this case, the method of diagnostic laparoscopy is used, the contents of the cyst are selected for histology (microscopic examination).

Preparing for a planned operation

Before planned operation to remove the cyst, the woman is being examined. At the same time, blood clotting, group and Rh factor are established, urine and blood tests for sugar are performed. Blood is also examined for the presence of pathogens of syphilis, HIV, hepatitis.

An abdominal operation requires an additional examination to study the condition of cardio-vascular system, kidneys, endocrine and other organs. 7 days before the operation, a woman should switch to a diet: exclude the use of fatty foods and flour products, raw vegetables and fruits, as well as other foods that cause increased gas formation and bloating. Between the last meal and the operation should be at least 10 hours. Take a laxative in the evening. In the morning before the operation, the intestines are cleansed with an enema.

Video: Preparing and performing ovarian surgery

Carrying out operations in various ways

The main methods of surgical intervention are laparoscopy and laparotomy. Applies also laser removal. The procedure can be planned, as well as emergency, when the question of the scope of the intervention is taken in the course of its implementation.

Laparoscopy

The cyst is removed through holes in the peritoneum. Manipulations are controlled using a video camera (endoscope), which is inserted into the abdominal cavity through a small puncture. Two more punctures are made for the introduction of instruments. The progress of the operation is reflected on a special screen, which allows the surgeon to act with great precision.

The operation is carried out under general anesthesia. Before removing ovarian cysts, carbon dioxide is injected into the abdominal cavity so that the walls of the organs do not stick together and are clearly visible.

The procedure is carried out in stages. First, the cystic capsule is pierced and its contents are aspirated, and then the membrane is removed. This is done so that the cyst does not burst during extraction, and its contents do not enter the abdominal cavity. After rinsing the cavity antiseptic solution and removal of gas, the punctures are sutured. They are so small that only subtle seams remain. The operation lasts approximately 30-60 minutes.

After it, after a few hours, the patient is allowed to get up. After 4-5 days, she is discharged from the hospital. The stitches are removed after 6-7 days. In the early days, antibiotics and painkillers are prescribed to prevent complications and alleviate the woman's condition.

Complete healing occurs in 4-5 weeks.

Video: How a laparoscopy of a cyst is performed

laser operation

It differs in that a laser beam is used instead of surgical instruments. In this case, simultaneous cauterization of damaged blood vessels is performed. The procedure is bloodless, takes place with minimal risk to the health of the patient.

Laparotomy

This is an abdominal operation in which an incision is made on the abdomen under the navel. Through it, a severed cyst or ovary is removed along with a neoplasm. A laparotomy is performed in cases where the cyst is too large (more than 10 cm in diameter), there are adhesions, suppuration of the cyst occurs, twisting of the leg, and others. emergency situations. Laparotomy also removes cancerous cystic neoplasms.

This method is used to remove ovarian cysts found in a woman. menopausal age. In this case, as a rule, regardless of the location of the cyst, both ovaries are removed (sometimes even together with the uterus), since the risk of cancerous degeneration increases significantly with age.

The operation takes about 2 hours. This method is the most traumatic, there is a risk of infection, damage internal organs, the appearance of adhesions. For several days, the patient must remain in the hospital under the supervision of doctors. On the full recovery health takes 2-6 months.

Seams until they are completely healed must be treated with antiseptics. It is recommended to use ointments that accelerate healing and prevent scarring. After 2 weeks, a control ultrasound is done.

Removing a cyst during pregnancy

If a neoplasm is detected after pregnancy, then the approach to treatment is purely individual. If it is small, the tactics of monitoring the condition with the help of ultrasound is chosen.

With a noticeable increase in the cyst, the threat dangerous complications increases, so it is removed at any stage of pregnancy. If possible, laparoscopy is performed. With a rapid increase and suspicion of cancer, a laparotomy is performed. This increases the risk of fetal death and sharp deterioration the condition of the woman herself.

Possible complications and consequences

After the operation to remove the ovarian cyst, in rare cases, complications associated with individual intolerance occur. medicines(antibiotics, drugs).

Possible consequences may be infection of wounds, the occurrence of bleeding, the formation of blood clots in the blood vessels. A specific, extremely rare complication is accidental damage to the ovaries, fallopian tubes, bladder, or intestines during cyst removal.

Perhaps the formation of adhesions around the ovaries, which subsequently become the cause of infertility. Approximately 15% of women operated on have this pathology. There is a possibility of recurrence of cysts after a cystectomy.

A warning: How harder operation the higher the likelihood of complications. Therefore, it is so important to undergo regular gynecological examinations of the condition of the genital organs, during which neoplasms can be detected on the initial stage their development.

Recovery of hormonal levels occurs within 4-6 months. During the rehabilitation period, a woman may be in a state of depression, feel hot flashes, as with menopause. After the use of anesthesia, problems such as heart palpitations, increased blood pressure, headaches, and insomnia appear.

You should consult a doctor as soon as possible if, after removal of the ovarian cyst, there is reddening of the suture, sanious discharge from the wound.

Recovery of menstruation should occur in 1-3 months. If they linger, become scarce, appear spotting or purulent discharge from the genitals, this indicates the occurrence of diseases of the appendages. If bleeding or pain in the abdominal cavity occurs in the postoperative period, a doctor should be consulted immediately.

During the recovery period after surgery, a woman should not lift anything heavy, perform sports exercises associated with bending, tension in the abdominal press. Needs to be adjusted digestive system to avoid constipation or intestinal upset.

Thermal procedures should be avoided. Sexual relations can be resumed after 1 month, but pregnancy can be planned no earlier than 3 months after the operation.

Video: Recovery of a woman after a laparoscopy operation

All materials on the site are prepared by specialists in the field of surgery, anatomy and specialized disciplines.
All recommendations are indicative and are not applicable without consulting the attending physician.

An ovarian cyst is one of the most common benign tumors in women. According to statistics, every tenth woman has ever received treatment for this pathology (operative or conservative). Recently, the diagnosis of ovarian cystic formations has increased significantly, which is associated with the advent of ultrasound devices of an expert class, as well as the implementation of highly informative diagnostic methods - MRI and CT of the pelvic organs. Attention to ovarian cysts has always been high, and this is fully justified. According to the results scientific research benign education can become malignant under the influence of certain factors. That is why the surgical approach prevails in the treatment of ovarian cysts, as the most radical and effective method of treatment.

Not all ovarian cysts are “equally dangerous”

Cystic ovarian formations can differ both in their structure and in the degree of “danger”.

It is customary to distinguish the following morphological variants of cysts:

What causes ovarian cysts?

To the most common reasons that cause benign neoplasms of the ovaries include:

Diagnosis of ovarian cysts

You can find this formation in the following ways:

• On examination (large cysts are easily identified using a conventional palpation in the appendages).
• ultrasound- Diagnosis is the simplest and most common diagnostic method. During ultrasound it is possible to determine the size, localization, contents of the cyst, the thickness of the capsule, the features of the blood flow.
• MRI and CT although more expensive methods, however, they allow the most detailed study of cystic formations.
• Diagnostic laparoscopy used in rare and complex doubtful cases. When a cyst is found, it is usually removed.

To remove or to treat: that is the question?

The detection of an ovarian cyst does not always mean that a woman needs surgery. Medical treatment functional cysts (follicular, corpus luteum) lend themselves very well, as well as cysts as a result of the inflammatory process. Surgery can also be avoided with timely treatment of endometrioid cysts. small sizes.

It is completely useless to treat dermoid cysts, they are not affected by drugs.

With regard to hormonally active cysts, large endometriodinous, and giant (more than 8-10 cm) serous and mucinous cysts, surgical tactics prevail in doctors, since they are the most dangerous.

It is important to remember about such a serious complication as cyst rupture. This condition may be accompanied by intra-abdominal bleeding, which threatens the woman's life. Therefore, upon discovery large cysts do not delay with surgical treatment, which is better to perform in a planned manner than in an emergency.

How is the preparation for the operation going?

It is important for patients to understand that the removal of an ovarian cyst (no matter how) is an operation that is accompanied by entry into the abdominal cavity. And this means that the preparation for such an intervention, of course, must be serious. In addition, in some situations, it may be necessary to expand the scope of the operation originally envisaged. For these reasons, the preparation should be very serious and include the following points:

Laparoscopic cyst removal

To date, the vast majority of such operations are performed using laparoscopic techniques.

The operation is carried out as follows:

Video: laparoscopic removal of an ovarian cyst

How is an “open” abdominal operation performed?

An operation to remove an ovarian cyst is sometimes performed open (or laparotomically).

The course of the operation is as follows:

1. The anterior abdominal wall is dissected in layers (skin, fatty tissue, aponeurosis, muscles are bred to the sides, a sheet of peritoneum is opened).
2. Deleted cystic formation, and also, if necessary, adhesions are dissected, carefully examined the fallopian tubes, uterus).
3. With endometrioid cysts, it is also important to examine the intestines, omentum, peritoneum, and vesicouterine fold. If they have endometrioid lesions, it is desirable to remove them (sometimes related specialists are invited to the operating room - abdominal surgeons, urologists).
4. After a thorough stop of bleeding, an anti-adhesion gel (“Katejel”, “Mesogel”, “Intercoat”) is sometimes introduced into the abdominal cavity, which prevents the formation of adhesions in the future.
5. The layers of the abdominal wall are sutured in reverse order.

Often patients are concerned about questions: what will it look like postoperative suture, what size will it be, and will the skin on the abdomen be cut longitudinally or transversely?

There is no unequivocal answer to all these questions, since many surgeons individually approach the choice of surgical access, suture material.

But in general, most surgeons perform this operation using a transverse suprapubic incision (according to Pfannenstiel), which is considered the most common.

The wound is also sutured with a cosmetic suture.

In rare cases, doctors remove an ovarian cyst using a lower median incision (longitudinal from the navel to the pubis). This is usually done with questionable results blood tumor markers (when the possibility of expanding the volume of the operation is allowed), with a severe adhesive process, or the presence of hernias on the anterior abdominal wall.

Laparoscopic versus laparotomy: which is better? (Gynecologist's view)

One of the most frequently asked questions from patients is the choice of surgical approach.

Of course, laparoscopic surgery has many significant advantages:

• Early activation of the patient;
• Easier postoperative period;
• Less pain after surgery;
• Postoperative adhesive process develops less often;
• No risk for hernia development;
• Less anesthesia load (as a rule, laparoscopic operations are faster than open ones).

But it is important to know that this method cannot be used in absolutely all patients, since it has a number of serious contraindications.

Thus, at detailed study this question, it becomes obvious that these methods do not “compete” with each other, but simply complement. Where laparoscopic surgery cannot be performed, an open method of cyst removal comes to the rescue.

Simply put, the operating doctor should not be a supporter of one method or another, on the contrary, he must be fluent in all methods. And in The choice of operational access should be carried out individually in accordance with the indications, as well as data from additional studies.

An important question: what type of anesthesia is best?

Often, patients are concerned about the upcoming anesthesia. In this operation, it is successfully used as general anesthesia and regional methods of anesthesia (spinal, epidural). It is better for emotional and anxious women to have general anesthesia so that they do not worry during the operation.

However, spinal anesthesia compares favorably in that there is no process of getting out of anesthesia, because the patient is conscious all the time. Unfortunately, this method also has many contraindications: diseases of the spine, a violation of the blood coagulation system, a large amount of blood loss (more than 1000 ml).

Recently, the number of patients with tattoos in the lumbar region has been increasing, just at the site of the proposed injection of the drug during spinal anesthesia. It is undesirable for this category of women to carry out this method of anesthesia, since they are likely to develop serious inflammatory complications of the spinal cord.

Pregnancy and cyst: how compatible?

Sometimes pregnancy occurs against the background of a cyst in a woman. But situations are also possible when an ovarian neoplasm appears precisely during the period of bearing a child. How to be in such a situation?

You should not worry at all when a small-sized corpus luteum cyst is found on one of the ovaries. The fact is that before the 16th week of gestation, when the placenta is not yet fully formed, the production of the hormone progesterone (very important in the development of a normal pregnancy) occurs precisely in the ovary. Thus, a corpus luteum cyst is nothing more than a manifestation hormonal function ovaries during this period. Therefore, it is not necessary to remove this cyst, especially since it can even provoke spontaneous abortion.

In addition, it is quite obvious that any operation is a serious risk for the development of the baby.

That is why during pregnancy are subject to removal:

• Large cysts that may rupture
• If a malignant nature of the formation is suspected;
• When the cyst ruptures, torsion of the leg of the cyst.

The most ideal period for the operation is 18-20 weeks. Why?

On the one hand, the most dangerous first trimester is already over, and on the other hand, the size of the uterus is not yet so large that it makes it possible to remove the cyst by laparoscopic access.

At a later date, an open operation is performed.

Sometimes women are concerned about the question: is it possible to get pregnant after removing the cyst?

If only the cyst was to be removed, and the ovarian tissue (at least one) was preserved, then the woman has every chance for the onset desired pregnancy. Moreover, sometimes it is a cyst (especially a hormonally active one) that causes a woman's infertility. In such cases, after the operation, the likelihood of getting pregnant even increases.

Price question: how much does this operation cost?

Women who have found a cyst should not despair at all and worry that they will not have enough money for treatment. This operation can be carried out absolutely free of charge. To do this, a woman just needs to contact the antenatal clinic at the place of residence. The doctor will write directions for necessary tests. And after receiving the results of the study, he will be sent to a state institution, where the surgical intervention will be performed.

Thus, the operation is performed free of charge for women who have:

1. Valid insurance policy;
2. Survey results;
3. Referral to the gynecological hospital from the antenatal clinic.

To remove giant, as well as endometrioid cysts with common foci of endometriosis, the doctor can issue a quota. Such an operation will also be carried out completely free of charge.

However, if the patient wishes to contact private clinic to perform such an operation, the prices will differ significantly from the region. For example, in the clinics of the capital, the cost of the operation is about 40-50 tr. In cities that are large regional centers, this operation can be completed for 25-30 tr. In less populated cities, this intervention will be even cheaper (about 15-20 thousand rubles).