Is surgery necessary for cystic formation? What to do with an ovarian cyst during menopause

Ovarian cyst removal- a question that has confronted a woman more than once in her life. Unfortunately, this pathology is common in women of childbearing age, and in postmenopausal women it requires special attention and quick treatment tactics.

Of all cysts, a larger percentage falls on benign ovarian tumors. It is important to remember that many formations have a risk of malignancy - malignancy, therefore clinical observation is very important for the purpose of early detection of the disease.

The classification of cysts is primarily based on the structure and origin of a particular tumor. This classification is quite complex and is mostly used by histologists after conducting a specific study.

It is customary to distinguish a separate group of formations - those that arise in case of dysregulation of the menstrual cycle.

The most common cysts in the practice of a gynecologist are corpus luteum cysts, endometriotic cysts and teratomas.

Causes

Among the most common are dysregulation of the menstrual cycle, lack of normal ovulation, and disruption of follicle maturation processes.

Endometrioid cysts are an external form of endometriosis, a systemic hormone-dependent disease. The appearance of teratomas is based on disturbances at the stages of embryogenesis; these types of tumors are always congenital and can occur in both ovaries.

Extragenital causes include dysfunction of the thyroid gland, obesity, prolonged stress and emotional stress, poor lifestyle, and frequent abortions.

There are no clearly defined causes of cysts. Often a combination of several factors play a role.

Symptoms

Many tumors may not manifest themselves at all and may be discovered during the next routine examination, especially during an ultrasound examination.

In some cases, patients complain of nagging pain in the lower abdomen, pain during sexual intercourse, and atypical intermenstrual bleeding.

If the cyst grows to a very large size, it can put pressure on the rectum or bladder and lead to difficulty defecating and urinating.

Diagnostics

If the size is significant, the doctor can detect the formation during a routine bimanual examination on the gynecological chair; if the cyst reaches gigantic proportions, then it can even be felt through the anterior wall of the abdomen.

Smaller tumors are best diagnosed with routine ultrasound. This method allows you to evaluate the exact size, structure and expected nature of the formation.

The doctor also conducts a Doppler examination of the vessels feeding the cyst. Additional instrumental methods are computed magnetic resonance imaging.

These studies may be prescribed if the location is atypical or difficult to visualize on ultrasound.

From laboratory tests, it is necessary to determine the tumor markers CA-125 and HE4. They help indirectly assess the benign nature of the tumor.

When is surgery to remove a cyst necessary?

Ordinary functional cysts do not need to be operated on. As a rule, they go away on their own after the next menstruation starts.

The doctor can prescribe a course of gestagens or combined oral contraceptives for up to 3-6 months, which almost always lead to a cure for the patient.

If there is no effect from hormonal therapy, we have to talk about the non-functional nature of the formation and change tactics from conservative to surgical.

Endometrioid cysts should be removed if they are large and/or affect the overall hormonal balance. Such tumors often underlie endocrine infertility.

Teratomas and cysts that cannot be treated with medication, they must be removed surgically, because they have a very high risk of malignancy.

You should definitely know about this, during which a hormonal surge occurs. Such conditions can cause unpredictable and uncontrolled growth of the formation.

Women planning extracorporeal surgery are required to undergo surgery before entering into the protocol.

So, in what cases should you operate immediately?

It is carried out as an emergency if there is severe persistent pain in the lower abdomen with irradiation to the rectum, or problems with the general condition (drop in blood pressure, nausea, vomiting).

These symptoms indicate serious complications of cysts - torsion or rupture of the capsule with bleeding into the pelvic cavity. These complications pose a significant danger to a woman’s life.

The slightest sign indicating a complication of the structure of the formation, rapid growth of the tumor, severe compression of neighboring organs is also an indication for urgent removal of the cyst.

Preparation for surgical treatment

Of course, if indications for emergency surgery arise, there is no need to talk about preparation. If you are scheduled for a planned operation, the doctor will prescribe a list of mandatory tests and procedures.

These include determination of blood group and Rh factor, biochemical and clinical analysis of blood and urine, coagulation test, markers of HIV, hepatitis B and C, and syphilis.

Often, for education it is necessary to undergo gastroscopy and colonoscopy.

The therapist will look at fluorography of the lungs, ECG and assess the risks of complications from the cardiovascular system.

You must be prepared for the fact that if changes in laboratory tests are detected, consultation with related specialists may be required.

Types of surgical treatment

There are two main methods for removing ovarian cysts: laparotomy and laparoscopic.

1) Laparotomy is an abdominal operation with a layer-by-layer incision of soft tissues and the same layer-by-layer suturing after the end of the intervention.

This type is used in case of emergency, bleeding into the abdominal cavity. Laparotomy allows you to quickly get to the ovaries, remove the problematic formation and carry out thorough hemostasis.

At the end of the operation, the surgeon places a special tube - drainage for the outflow of pathological fluid. Drainage also allows you to administer medications to the surgical area and wash it if necessary.

Laparotomy access is also used for very large tumors, when a wide surgical field is needed, in complex clinical cases.

2) Laparoscopy is considered a more gentle and, undoubtedly, advanced method. During this method, penetration into the pelvic cavity occurs through small incisions in the navel and ilium. The length of these incisions rarely exceeds 10 mm and averages about 5-7 mm. A puncture of the abdominal wall is carried out with a trocar, through which gas is pumped into the cavity and a telescope with a camera and a light source are connected.

The camera displays a clear image of the internal organs on a large screen. The surgeon's assistant rotates the camera so as to completely show the operating doctor the area of damage and controls the location of the operating area in the center of the screen.

Instruments for surgery, called manipulators, are inserted through incisions in the lower abdomen.

Laparoscopy is part of minimally invasive surgery, has a very low complication rate and does not require long recovery.

This method of intervention can also be used for diagnostic purposes, when it is necessary to determine further tactics and the need for more radical measures.

Of course, this method also has its drawbacks. Insertion of instruments requires some time, and large formations are difficult to remove through narrow manipulator guides. Massive bleeding during surgery greatly limits the surgeon's capabilities.

If before the operation there was the slightest suspicion that the tumor was of a substandard nature, during the intervention itself an emergency histological examination is carried out, the results of which determine the further course of the operation, the need to invite additional specialists, and the area of removal of ovarian tissue.

Be that as it may, any material obtained during the operation is sent to the laboratory for a thorough study of its nature of origin. The result of this study determines further conservative tactics and often determines the chances of pregnancy.

Laser removal

Methods similar to laparoscopic ones include laser removal of ovarian cysts. This method is used for small formations.

First, local anesthesia of the skin is performed, and then a special thin instrument is inserted. The advantage of this technique is that the laser emanating from the instrument has a good hemostatic effect.

Laser removal is a fairly promising area in minor surgery that does not require general anesthesia.

Complications

Any operation has its own risks and complications. Despite the more gentle technique, during laparoscopy injuries to neighboring organs are possible; the trocar is inserted into the abdominal area blindly and there is always a minimal risk of injury to large blood vessels.

Laparotomy has an order of magnitude greater number of complications. In addition to those mentioned above, there are risks of unsuccessful hemostasis and the occurrence of postoperative bleeding and adhesions.

Features of the recovery period

Recovery after laparoscopy is almost painless. A woman may feel slight pain and discomfort in the lower abdomen, but her general condition is rarely affected.

You are allowed to get up after surgery the very next day; hospital stay usually does not exceed 7 days.

Abdominal surgery requires much longer rehabilitation. The postoperative period is accompanied by pain of varying intensity, requiring the administration of painkillers.

It also takes some time to restore independent urination and defecation.
Typically, women stay in the hospital for up to two weeks and sick leave is issued for a longer period than for laparoscopic surgery.

In the early postoperative period, the doctor will prescribe a course of antibacterial and anti-inflammatory therapy to prevent infectious complications.

For a month, you should refrain from physical activity, sexual activity, and avoid going to baths and saunas.

It is advisable to prescribe a short course of hormonal therapy to give the ovaries a “rest” after surgery.

Unfortunately, there is always a risk of recurrence of cysts on the ovaries, so a woman needs to be regularly observed by a gynecologist, undergo routine ultrasound examinations, and maintain a healthy lifestyle.

A functioning female reproductive system without deviations is the key to full life sensations, because the opportunity to have children is a gift from nature itself. Unfortunately, the modern world is not without specific diseases associated with women's health. Pathologies of the reproductive organs are quite common. Endometrioid ovarian cyst is a disease that negatively affects the possibility of conception. Its complications can be so serious that removal of the endometrioid ovarian cyst is the only option to avoid severe consequences.

The cyst is formed during the implantation of endometrial cells into the ovarian tissue. How do these cells, which form the basis of the inner uterine layer, end up outside the uterus? The reason for this is endometriosis, a gynecological hormone-dependent disease of unknown etiology. A cystic formation is formed against the background of this pathology, the essence of which is the movement of cells of the internal uterine layer outside the boundaries of the uterus. Cells of a healthy uterus retain its layer-by-layer structure and do not allow cells to move from layer to layer and beyond the outer boundaries of the organ.

But with endometriosis, an anomaly occurs, expressed in the migration of cells from the endometrial (inner) uterine layer to other tissues. This causes the formation of structures uncharacteristic for such tissues in the form of foci that function like the lining of the uterus, growing and being rejected in a cyclic cycle with bloody discharge, as happens during menstruation.

If endometrial cells enter the ovary through the fallopian tubes, then its loose structure, due to the periodic maturation of follicles, poorly prevents their penetration. These cells in the thickness of the ovarian tissue gradually form a capsular cavity, which, functioning like the uterine layer, is filled with blood.

Clinical signs of cysts and complications

In terms of its symptoms, the course of the disease manifests itself differently, depending on the stage of the pathological process. If hormonal parameters do not deviate from the norm and the cystic formation grows slightly, then no pronounced symptoms are observed. The progression of the disease leads to:

to the appearance of aching painful sensations in the lower abdomen, which are more intense on the right, if it is an endometrioid cyst of the right ovary, and on the left, if the left ovary is affected;
to pain along the entire line of the lower abdomen with bilateral development of the process;
to heavy blood loss during menstruation and spotting during the intermenstrual period;
to general weakness, malaise, mild nausea;
to frequent urination;
to unsuccessful attempts to get pregnant.

Untimely treatment of the pathology provokes secondary complications:

problems with the maturation of eggs in the ovaries that have undergone structural changes due to the functional activity of the endometrioid cyst;
compression and deformation of the ovarian body due to a growing tumor;
inflammation and development of suppuration at the location of the cyst;
scarring of the ovarian region of the ovaries due to the proliferation of cystic structures;
the appearance of adhesions in closely located tissues of neighboring pelvic organs.

All these abnormal processes lead to disruption of a woman’s reproductive functions and interfere with the normal process of conception, which results in infertility.

But the most dangerous condition can develop when the cystic capsule ruptures, when its bloody contents leak into the abdominal cavity. The woman feels a paroxysmal acute pain in the abdomen, a sharp drop in pressure is recorded, the body temperature rises significantly, and the condition is close to fainting. In this case, emergency medical care in a hospital through surgical intervention is indicated.

Diagnostics

An endometrioid cyst is not easy to recognize. An examination by a gynecologist provides general information about the presence of a formation on the ovary and its approximate size. To obtain a more detailed picture, an ultrasound examination is prescribed. Ultrasound scanning makes it possible to accurately identify the location of the capsule with its contents, determine the size of the tumor, examine the pelvic organs, and monitor the development of the process over time.

However, ultrasound cannot always reliably determine the origin of the tumor and differentiate the endometrioid type from other variations. In particular, the MRI method allows, in special modes, to recognize the presence of fatty inclusions in the cystic contents along with blood, which is typical for a dermoid cyst.

The patient is recommended to undergo laboratory blood tests for hormone levels and the tumor marker CA-125, the level of which is sometimes elevated in the presence of an endometrioid cyst. The results of cyst puncture, carried out with a special instrument with a needle for puncturing the capsule and the ability to suction out the cystic contents, are also examined in the laboratory.

The only modern method that determines the nature of the disease with absolute reliability is laparoscopy. It gives the doctor the opportunity to visually assess the degree of pathology by introducing a special sensor with a mini-video camera through a puncture in the peritoneum, and, if necessary, begin treatment immediately. Therefore, laparoscopy has not only a diagnostic, but also a therapeutic direction.

Timely diagnosis of an endometrioid ovarian cyst will make it possible to begin comprehensive treatment and eliminate disturbances in the functioning of the woman’s reproductive system.

How does an endometrioid cyst affect pregnancy?

The onset of pregnancy with this type of cyst is a big problem, since the ovarian tissue suffers, and, as a result, the process of egg maturation is disrupted. We must not forget that the appearance of the tumor is caused by endometriosis, often accompanied by hormonal dysfunction. And this, in turn, leads to problems with ovulation.

What to do if a woman has not regularly visited the gynecologist, pregnancy has already occurred, and upon examination a small cyst is discovered? When positive dynamics of her growth are not noted, then the woman must be observed by a gynecologist throughout the entire period of pregnancy. However, if the cyst grows rapidly, its removal is indicated, as this may negatively affect the pregnancy of the baby. Therefore, the surest way is to regularly visit your doctor and solve the problem before conception.

Development of treatment tactics

Women who are diagnosed with an endometrioid cyst ask the question: should they remove it or not? Among patients with this diagnosis, there is a common misconception that removal of the tumor is always carried out together with the ovary. In reality, this is not the case. Small cysts that do not affect the functions of other organs often disappear after competent complex therapy. Drug treatment of a hormonal, immunostimulating and restorative nature is prescribed.

The expediency of surgical intervention often depends on the timeliness and correctness of treatment tactics. Experts recommend the drug Visanne. Its active substance, dienogest, can inhibit the growth of endometrioid tissue and restore hormonal levels. However, the success of such treatment is not yet an indicator of complete recovery. Endometriosis is a recurrent pathology, so there is a risk of the formation of new lesions.

Radical surgery methods

If the conservative method does not produce positive results, and further growth of formation is noted, surgical intervention cannot be avoided. But women need to know that even if surgery is necessary, gentle options are possible that will eliminate the cyst but preserve part of the ovary. The determining factors in the development of therapeutic measures are:

type and size of cystic formation;
severity of symptoms;
age category of the woman;
the feasibility of preserving reproductive function.

The extent of the surgical intervention is assessed by the doctor. Depending on the course of the disease, the following are possible:

surgery to excise the cyst while preserving the ovarian tissue of the appendages;
elimination of cystic formation without interfering with the functional activity of the ovaries;
removal of the cyst together with the affected ovary.

Previously, access to the affected organ was provided through an incision in the abdominal wall, but modern laparoscopic techniques are a minimally invasive intervention. After 3-4 punctures in the peritoneum, special manipulator tubes with instruments and a video camera are inserted, and the whole process is displayed on the monitor. For spatial freedom of movement and complete visualization, gas is injected into the peritoneal cavity, the action of which contributes to the elevation of the abdominal wall.

The removal operation is performed taking into account the following features:

the endometrioid cyst is removed, taking care not to touch the follicles with maturing eggs “soldered” to it, so as not to reduce the volume of the follicular reserve;
the ovarian cyst is excised with care, without damaging the nearby blood supply vessels, since this can disrupt the nutrition of the appendage and negatively affect its function;
In addition to the cyst itself, it is necessary to determine the localization of existing endometrioid foci, eliminating them by coagulation (cauterization).

A proven gentle technique is laparoscopy, which involves opening the capsular part with subsequent evacuation of the contents through a special suction. Capsular tissues freed from liquid filling must be removed, since they can subsequently become the source of a new focus of pathology.

In complicated cases, surgery is performed to remove the cystic formation without preserving the ovarian tissue:

Endometrioid cysts that have reached large sizes in their growth, as a rule, lead to structural changes in the ovary that are irreversible. Therefore, preserving an ovary that has lost its basic functions is considered inappropriate.

At an age close to perimenopause, a woman’s hormonal background undergoes changes. Because of this, the body cannot cope with the pathology of proliferative processes. It is possible that, against the background of hormonal dysfunction, such a formation can trigger the onset of a malignant process.

Experts always notify women that eliminating a cyst does not lead to a complete recovery. After removal of an endometrioid ovarian cyst, it is necessary to restore the normal balance of hormones, which is achieved by subsequent courses of well-chosen individual hormonal therapy.

Solving the problem of endometrioid cyst recurrence

Recurrence of an endometrioid cyst is a problem that must be solved with the participation of a competent gynecologist and an experienced surgeon. The highly qualified doctor performing laparoscopy will make it possible to perform an operation not only to remove the cyst, but also to eliminate during the intervention all foci that contribute to the development of recurrent phenomena. After the operation, it is necessary to regularly visit the treating gynecologist and conscientiously follow all his instructions, which will be the key to getting rid of chronic endometriosis.

For patients of childbearing age, after laparoscopy and complete postoperative recovery, it is preferable to plan pregnancy. The course of pregnancy and the associated restructuring of the female body contribute to the restoration of the structure of the endometrium of the uterus and do not allow the formation of new endometriotic foci. But you need to take into account that you need to try to get pregnant on your own within a year or a year and a half. If such attempts are unsuccessful, after agreement with the doctor, you can resort to IVF.

The main task of preventing relapses is the removal of all existing endometriotic lesions and individual adequate hormonal treatment.

All materials on the site were prepared by specialists in the field of surgery, anatomy and related disciplines.
All recommendations are indicative in nature and are not applicable without consulting a doctor.

Ovarian cyst is one of the most common benign formations in women. According to statistics, every tenth woman has ever received treatment for this pathology (surgical or conservative). Recently, the diagnosis of cystic ovarian formations has increased significantly, which is associated with the advent of expert-class ultrasound devices, 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 quite justified. According to the results of scientific research, a benign formation 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 formations of the ovaries 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?

The most common causes of benign ovarian tumors include:

Diagnosis of ovarian cysts

This formation can be detected in the following ways:

Upon examination (large cysts are easily identified using conventional palpation in the area of the appendages).
Ultrasound– diagnostics is the simplest and most common diagnostic method. During an ultrasound examination, it is possible to determine the size, location, contents of the cyst, capsule thickness, and blood flow features.
MRI and CT Although more expensive methods, however, they allow you to study cystic formations in as much detail as possible.
Diagnostic laparoscopy used in rare and complex doubtful cases. If a cyst is detected, 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. Functional cysts (follicular, corpus luteum) respond very well to drug treatment. as well as cysts as a result of the inflammatory process. It is also possible to avoid surgery if the treatment of small endometrioid cysts is started in a timely manner.

It is completely useless to treat dermoid cysts; drugs do not affect them.

With regard to hormonally active cysts, large endometriotic cysts, and giant (more than 8-10 cm) serous and mucinous cysts, doctors prefer surgical tactics, 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, if large cysts are detected, you should not delay surgical treatment, which is better performed as planned rather than emergency.

How do you prepare for surgery?

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

Laparoscopic cyst removal

Today, 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 “open” abdominal surgery performed?

Surgery to remove an ovarian cyst is sometimes performed using an open (or laparotomy) approach.

The course of the operation is as follows:

The anterior abdominal wall is dissected layer by layer (skin, fatty tissue, aponeurosis, muscles are pulled apart, the peritoneum is opened).
The cystic formation is removed, and if necessary, adhesions are dissected, the fallopian tubes and uterus are carefully examined).
For endometrioid cysts, it is also important to examine the intestines, omentum, peritoneum, and vesicouterine fold. If there are endometriotic lesions on them, it is advisable to remove them (sometimes related specialists are invited to the operating room - abdominal surgeons, urologists).
After thoroughly stopping the bleeding, an anti-adhesive gel (“Categel”, “Mesogel”, “Intercoat”) is sometimes injected into the abdominal cavity, which prevents further formation of adhesions.
The layers of the abdominal wall are sutured in reverse order.

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

There is no clear answer to all these questions, since many surgeons take an individual approach to the choice of surgical approach and suture material.

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

The wound is also sutured using a cosmetic suture.

In rare cases, doctors remove an ovarian cyst using an inferomedial incision (longitudinal from the navel to the pubis). This is usually carried out in case of questionable results of blood tumor markers (when the possibility of expanding the scope of the operation is allowed), in case of severe adhesions, or the presence of hernias on the anterior abdominal wall.

Laparoscopic versus laparotomic approach: which is better? (the view of a gynecologist)

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

Of course, laparoscopic operations have many significant advantages:

Early activation of the patient;
The postoperative period is easier;
Less pain after surgery;
Postoperative adhesions develop less frequently;
There is no risk of developing hernias;
Less anesthesia load (as a rule, laparoscopic operations are performed faster than open ones).

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

Thus, when studying this issue in detail, 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 should be fluent in all techniques. And in The choice of surgical access should be made individually in accordance with the indications, as well as data from additional studies.

An important question: which type of anesthesia is better?

Often patients are concerned about the upcoming anesthesia. During this operation, both general anesthesia and regional anesthesia methods (spinal, epidural) are successfully used. For emotional and anxious women, it is better to undergo general anesthesia so that they do not worry during the operation.

However, spinal anesthesia is advantageous in that there is no process of recovery from anesthesia, because the patient is conscious all the time. Unfortunately, this method also has many contraindications: diseases of the spine, disorders of the blood coagulation system, large amounts of blood loss (more than 1000 ml).

Recently, the number of patients with tattoos in the lumbar region, right at the site of the intended injection of the drug during spinal anesthesia, has been increasing. It is undesirable for this category of women to undergo this method of anesthesia, since they have a high probability of developing serious inflammatory complications of the spinal cord.

Pregnancy and cyst: how compatible?

Sometimes pregnancy occurs against the background of a woman’s cyst. But situations are also possible when an ovarian tumor appears precisely during the period of bearing a child. What to do in such a situation?

There is absolutely no need to worry if you find a small corpus luteum cyst on one of the ovaries. The fact is that until 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 in the ovary. Thus, a corpus luteum cyst is nothing more than a manifestation of the hormonal function of the ovary during this period. Therefore, there is no need to remove this cyst, especially since this can even provoke spontaneous abortion.

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

This is why during pregnancy the following must be removed:

Large cysts that may rupture;
If a malignant nature of the formation is suspected;
In case of cyst rupture, or twisting of the cyst leg.

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

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

At a later stage, open surgery is performed.

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

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

Cost question: how much does this operation cost?

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

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

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

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

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

An ovarian cyst is a liquid formation filled with secretion, which belongs to tumor-like processes and is not a true tumor. Therefore, it should be treated non-operatively whenever possible. Surgical intervention is resorted to only in the presence of any complications, which include, for example, torsion of the cyst.

Ovarian cyst in most cases it occurs in women under fifty years of age, and often their course does not manifest itself with any symptoms. The presence of a formation is determined using ultrasound, a vaginal probe, vaginal examination or laparoscopy. Often the formation is discovered by chance during the next examination.

Folk remedies against cysts

You can make local baths for medicinal purposes, for which preparations are prepared from herbal infusions.

For example, you can mix equal amounts of pine uterus, birch leaves, blueberries and cuffs, and tansy flowers.

The second collection is oak bark, wormwood grass, violets and geraniums, chamomile flowers.

Another one is calendula flowers, knotweed root, plantain leaf, bird cherry fruits, and herbs agrimony, yarrow and thyme.

A good composition of equal amounts of marshmallow root, aspen bark, and wormwood herb.

You can try a mixture of fireweed leaf, bergenia root and herbs lavender and tricolor violet.

More like this popular fees for the treatment of cysts prepared with an equal ratio of ingredients:

flax seeds, viburnum bark, clover flowers, celandine grass and horsetail;
birch and coltsfoot leaves, nettle grass, juniper and bird cherry fruits;
angelica root, mint and St. John's wort, calendula and meadowsweet flowers, blueberry leaf and dandelion root;
mint and sweet clover herbs, and eucalyptus leaf;
licorice root and elecampane, wormwood herb.

To prepare the infusions that are necessary for local baths, you should brew tablespoons of the crushed collection with two glasses of boiling water and then keep it in a boiling closed water bath for a little over a quarter of an hour, leave for an hour. The finished infusion should be filtered and brought to two liters with boiled water. This infusion is used for sitz baths; the procedure should last about a quarter of an hour. The baths are done once or twice a day, and the full course is ten to twelve baths. Herbal medicine allows you to achieve improvement after a couple of weeks of regular use, but a lasting effect is achieved by regularly repeating courses for about a year.

Whether it is necessary to remove an ovarian cyst is a serious question. Surgical removal of an ovarian cyst is usually prescribed when therapeutic and drug treatment is impossible or unsuccessful, or a cancerous process is suspected. Only a specialist can decide whether to remove an ovarian cyst or not.

If after 3–4 menstrual cycles or under the influence of medications no positive changes in the resorption of the node are observed, the ovarian cyst is removed unless there are contraindications.

The surgical treatment tactics are determined by:

type of neoplasm, its size;
stage of the disease and degree of progression;
oncological prognosis;
associated pathologies.

How is the operation performed? The basic principle with any surgical method is to handle the ovary as carefully as possible to preserve its functioning.

Methods of surgical treatment

What method should be used to remove a tumor-like node?

Several methods are used to remove a cyst:

This is the most painless method for the patient.
Cyst puncture. It is used only when the formation is small and there are no signs of inflammation or cancer. A nozzle is inserted through the abdominal wall under local anesthesia, with which the wall of the capsule is pierced and the contents are removed from the cavity, after which sclerosis occurs (collapse of the walls).
Abdominal surgery or laparotomy. An open type of surgical intervention with a deep incision in the abdominal wall (up to 10–15 centimeters), performed under general anesthesia.

Laparotomy of the cyst

Although laparoscopy is more often used among surgical methods, there are a number of justified indications for which abdominal surgery to remove an ovarian cyst is prescribed. In case of a complicated process, it is not always possible to carry out the required amount of treatment using laparoscopy.

Emergency indications for surgery are the following urgent cases:

perforation (rupture) of the cyst capsule with leakage of internal exudate into the abdominal cavity;
suppuration of the cyst tissue with further penetration of pus into adjacent organs;
twisting of the leg-ligament, which leads to the knot suppurating;
hemorrhage into the peritoneum.

Such cases pose a direct threat to life, as they can quickly lead to blood poisoning, shock, massive bleeding and an irreversible coma.

Indications for routine removal of an ovarian cyst by laparotomy:

large neoplasm over 80 – 100 mm;
active growth in a short time;
development of a tumor-like node in the deep tissues of the gonad;
adhesions in the area of the reproductive organs;
suspicion of a cancer process or a confirmed diagnosis of oncology.

Advantages of laparotomy

Excision of a cyst on the ovary by abdominal surgery has a number of significant advantages:

Provides wider access to all pelvic organs.
Allows for emergency removal of a node in emergency conditions with examination of neighboring organs, and to take action if other pathologies are detected.
Provides an opportunity for a detailed study of the reproductive organs, tissue, lymph nodes, and areas with probable cancerous changes.
Provides the possibility of enucleation of an ovarian cyst (excision of the formation without opening the capsule), which eliminates the entry of pus or exudate into the peritoneal cavity and associated complications.
Allows for surgical intervention of any volume and complexity, which is especially important for malignant changes, when it is impossible to determine the degree of development of the process before surgery. At any time, you can expand the surgical field for manipulation and remove the uterus and appendages. In this case, complete excision of the affected organs takes place without the risk of heavy bleeding.
It is characterized by technical simplicity and does not require complex tools and equipment.

Contraindications

Laparotomy of an ovarian cyst in women has certain contraindications in which it can be dangerous. These include:

abnormally low blood clotting (hemophilia) and blood diseases;
persistent hypertension;
conditions with a high risk of cerebral hemorrhage, heart attack;
acute respiratory tract infections, severe asthma;
intolerance to anesthetics required for general anesthesia.

Preparation for laparotomy

Before surgery, the following studies must be performed:

blood group test, general and biochemical examination, Rh factor;
general and special urine analysis for kidney diseases;
coagulogram or determination of blood clotting (INR, PTI);
tests for sexually transmitted infections, HIV.

5 - 7 days before surgery, limit foods that provoke intestinal gas formation and allergies: fatty meats and smoked foods, carbonated drinks, beer, fruits, cabbage, legumes, black bread, spices, sweets made from flour and butter, milk.

The day before surgery:

It is necessary to empty the intestines using laxatives and an enema. The less space the intestinal loops take up, the more volume remains for surgical manipulation.
Stop eating 14 hours before surgery. A light dinner is allowed until 18:00, you can drink tea and water until 22:00.
On the day of the operation, do not eat breakfast or drink, so that during anesthesia a gag reflex does not occur and the airways are not blocked by stomach contents.

Carrying out laparotomy

How is the operation to remove a cyst performed? First, the skin is treated with antiseptics. The surgeon makes a cavity incision, for which two methods are used:

The incision is inferomedian, which is made vertically along the line between the pubic bone and the navel area.
Laparotomy according to Pfannenstiel. This is the main method in gynecology, in which a transverse incision is made along the fold of skin in the lower abdomen above the pubis. After healing, the scar will be invisible under the fold.

Then the surgeon opens the peritoneum layer by layer.

During laparotomy, the tumor can be removed by excision or enucleation:

Excision is more often used for several lesions, a deep-lying node, or fusion of the cyst with the gonad. Through the incision, the gonad is pulled out from the peritoneum. The area of the ovary where the cyst has developed is excised with a “wedge” and carefully sutured.
Enucleation of an ovarian cyst is carried out only when the benign nature of the formation is confirmed, since with this method the surrounding tissues are not affected. The process has another name – cyst desquamation. The entire capsule is removed, while care is taken to ensure that the cyst does not open and that the exudate does not leak out. Sometimes, to prevent rupture of the capsule walls, pus or exudate is drawn out of it.

If bleeding begins during surgical procedures, the vessel is doped (clamped), then bandaged or cauterized with high-frequency current (diathermocoagulation).

During laparotomy, the surrounding tissues are examined in order to:

detecting the growth of a node into the fallopian tubes, gonads, intestines and bladder tissue;
identifying possible cancer foci and excluding metastases.

In order to determine the nature of the tumor as quickly as possible, a biopsy of the ovarian cyst is necessary, that is, excision of a fragment of the affected tissue, and subsequent histological examination. If the formation turns out to be malignant, treatment is immediately prescribed.

Sometimes, if the doctor is concerned about the type of tissue, a biopsy and oncology analysis (histological examination) are done urgently, right during the operation.

If laparotomy is performed when there is a rupture of the cavity, a purulent process, or hemorrhage, then for 2–3 days the doctor will have to install drainage tubes so that all the fluid with pus and blood is removed from the peritoneal cavity.

How long does the surgical procedure take? The operation is classified as simple and lasts about 45 – 60 minutes.

On what day of the cycle should the operation be performed? To avoid increased bleeding, the node on the gonad should be removed 5–7 days after menstruation.

Types of laparotomy and extent of surgery

How is an ovarian cyst removed and what methods are used? When removing cystic nodes, several surgical techniques are used, which differ in the depth of surgical intervention and the volume of tissue removed.

Which surgical technique the surgeon will choose is determined by the type, size, location, degree of damage to the gonad, the nature of the nodule and the likelihood of cancerous degeneration.

Surgical techniques:

A qualified specialist is always concerned with the question of how to remove a cyst on an ovary, so as to affect as little tissue as possible and not have to cut out the ovary.

Possible complications

Possible consequences of removing an ovarian cyst:

severe pain in the suture area;
formation of adhesions;
postoperative bleeding;
inflammation of tissue in the suture area as a result of infection;
organ damage due to surgeon errors.

Recovery after laparotomy of an ovarian cyst

After removal of the ovarian cyst by laparotomy, the patient will have to stay in the hospital for 7 to 10 days under the supervision of specialists.

Within 30 – 60 days after suture removal:

Any physical exertion and lifting weights exceeding 1 kg are strictly prohibited;
taking a bath, visiting a bathhouse, sauna, swimming pool;
It is necessary to abstain from sexual activity after removal of an ovarian cyst for 2 months.

During this period, it is absolutely necessary to take vitamins. Depending on the type of cyst, as prescribed by the doctor, continue treatment with hormonal drugs and immunomodulators.

Pregnancy after cyst laparotomy

If only a cyst on the ovary or only one sex gland was removed, then a healthy ovary is capable of producing hormones and eggs. Therefore, the probability of conception after surgery for an ovarian cyst remains very high. Reproductive function will finally stabilize after at least 2 to 5 months have passed.

But conception within six months is undesirable, since incomplete restoration of ovarian function can lead to early miscarriage or tissue rupture in the suture area when the uterus enlarges. Therefore, it is advisable to plan a pregnancy no earlier than five to six months after laparotomy of the ovarian cyst.

Without surgery are disclosed in our separate work.