Do you have an ovarian cyst? Are you afraid of surgery? Let's talk (Ovarian Cystectomy)

Has the doctor told you that you have a cyst on your ovary and that you need surgery to remove it? It's normal to feel a little scared and nervous when you hear that. "What is this surgery?", "Will it hurt a lot?", "How long will it take to heal?", "Will I never be able to have children again?" A million questions probably come to mind. Don't worry. You are not alone. Today, we will talk about this surgery called `Ovarian Cystectomy`, which is the surgery to remove cysts on the ovaries, in a very simple way that you can understand.

First, let's see, what is an ovarian cyst?

Simply put, an ovarian cyst is a small, fluid-filled sac that forms on your ovary. Think of it like a blister on your skin. These are common conditions that most women develop. Most of the time, they go away on their own within a few months, without any problems or medication.

But sometimes these cysts can persist, grow larger, or cause pain. That's when the doctor decides to remove the cyst by surgery. This surgery is called an `Ovarian Cystectomy`.

What are the methods of performing this surgery?

There are two main types of surgery to remove ovarian cysts. Your doctor will decide which method is best for you based on your condition.

1. Laparoscopic Ovarian Cystectomy: This is the most common procedure today. Some people also call it "key-hole surgery." What happens here is that a very small incision is made in your abdomen, and a thin tube with a camera attached to it (a `laparoscope`) is passed into your abdomen. With that camera, the doctor can see everything inside your abdomen, including your ovaries and uterus, as if on a large TV screen. Then, two more small incisions are made in your abdomen, and the thin instruments needed for the surgery are inserted inside , and the cyst is very carefully cut out and removed.

2. Open Cystectomy / Laparotomy: This is the traditional method. Here, a slightly larger incision is made in the lower abdomen, the abdomen is opened, and the cyst is removed. The doctor chooses this method in a few special cases. For example:

• If the tumor is very large.
• If there is even the slightest suspicion that the tumor may be cancerous.

Here the difference between these two methods is even clearer.

Why do these ovarian cysts form?

It's hard to pinpoint a single reason for this. Several factors could be at play.

• Changes in hormonal function: Especially due to hormone-related conditions like PCOS (Polycystic Ovary Syndrome).
• Ovulation:Sometimes, these types of cysts can develop during the process of ovulation. It can also be caused by some hormonal medications used to help you conceive.
• Endometriosis: This is when the tissue that lines the inside of the uterus grows outside the uterus, such as on the ovaries. This can also cause cysts to form.
• Pelvic Inflammatory Disease: A severe infection of the reproductive system.
• Cancerous conditions: However, this is very rare. About 95 out of 100 ovarian cysts are not cancerous.

In what cases is surgery necessary?

As mentioned earlier, not all tumors need to be removed. However, your doctor may decide that surgery is a good idea for the following reasons:

• If the tumor is large in size: It is generally recommended to remove tumors larger than 2.5 - 3 inches (6-7 cm).
• If you have pain: Frequent, severe pain in the lower abdomen or back pain may be caused by this tumor.
• If there is a suspicion that the tumor may be cancerous: If such suspicion arises from scans and blood tests, the tumor will be removed to confirm and treat it.

How do you prepare before surgery?

Your doctor will give you all the instructions you need before the day of surgery. It is very important to follow them exactly.

• Food and Drink: Find out exactly how many hours before surgery you need to stop eating and drinking.
• Medication: If you are taking medication for another condition (e.g. diabetes, blood pressure), ask your doctor if you should take or stop taking that medication on the day of surgery.
• Ask questions: Ask your doctor any questions you have, no matter how small. Don't be afraid to ask.
• Someone to help: It's much easier to have someone to help you with household chores and take care of you for a few days after surgery.

What happens during surgery?

You don't have to worry about this too much. Because you will be under general anesthesia and sound asleep throughout the entire surgery. You won't feel anything.

The doctor will start the surgery after you fall asleep.

• In laparoscopic surgery: A camera is inserted through a small incision, and the abdomen is inflated with a small amount of carbon dioxide gas. This allows the doctor to see inside the abdomen clearly and perform the surgery. Then, instruments are inserted through other incisions to remove the tumor. Sometimes, a small piece of the tumor is sent for a biopsy to check for cancer. When the procedure is complete, the gas is removed, and the small incisions are closed with a type of dissolvable suture.
• In open surgery: A large incision is made, the tumor in the ovary is carefully removed, and the skin is sewn back together in several layers.

What will happen after the surgery?

After the surgery, you will be taken to a recovery room. You may feel some pain or discomfort when you wake up. The nurses will give you painkillers. Your heart rate and blood pressure will be monitored.

• If you had laparoscopic surgery, you will be able to go home in a few hours, either the same evening or the next morning.
• If you had open surgery, you will have to stay in the hospital for two to three days or more.

The doctor will give you a set of instructions to follow after you go home.

• Since when can you take a bath?
• How should wounds be kept clean?
• How long should I stop lifting weights and doing strenuous work?
• When should I come see the doctor again?
• What medicine should I take for the pain?
• How long should you abstain from sex?

Following all of this exactly is very important for a speedy recovery.

What are the benefits and risks of this surgery?

Advantages:

The main benefit is the removal of a tumor that was causing pain, discomfort, and possibly even becoming dangerous in the future. There are two serious complications that can occur due to ovarian cysts:

• Ruptured Ovarian Cyst: If the cyst suddenly ruptures, it can cause severe, unbearable pain.
• Ovarian Torsion: The weight of the tumor can cause the ovary to twist like a rope. If this happens, the blood supply to the ovary may be cut off, causing it to become completely inactive. This is also an emergency.

Surgery helps protect against things like this.

Risks:

As with any surgery, there are some minor risks, but these are very rare.

• Wound infection.
• Bleeding during surgery.
• Allergy to anesthesia.
• Blood clots in the legs.
• Regrowth after tumor removal.
• Very rarely, damage to the ovary or fallopian tube.
• Sometimes, if only the tumor cannot be removed, the entire ovary may have to be removed (`Oophorectomy`).

Your doctor will explain all of this to you. If you have conditions like smoking, diabetes, or obesity, the risk of complications is slightly higher.

The most important question everyone has: Can I have a baby after surgery?

But it's important to remember that the condition that caused your ovarian cyst (such as endometriosis or PCOS) can affect your ability to have children to some extent. Therefore, if you are hoping to have children in the future, it's very important to talk openly with your doctor about it before the surgery. He or she will give you the best advice.

If you have any of these symptoms after surgery, tell your doctor immediately.

If you experience any of the following symptoms after your surgery, do not panic and call your doctor immediately. Or go to the hospital's Emergency Department (ETU).

• If the wound is red, swollen, and pus is coming out.
• If you have a high fever and feel weak.
• If you have unbearable lower abdominal pain.
• If there is burning or pain when urinating.
• If there is excessive vaginal bleeding.
• If your legs are swollen and painful.