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Laparoscopic Ovarian Cyst – Symptoms, Diagnosis and Treatment

An ovarian cyst is any collection of fluid, surrounded by a very thin wall, within an ovary. Any ovarian follicle that is larger than about two centimeters is termed an ovarian cyst. An ovarian cyst can be as small as a pea, or larger than a cantaloupe.

Types of ovarian cysts :

Follicle cyst:
During a woman’s menstrual cycle, an egg grows in a sac called a follicle. This sac is located inside the ovaries. In most cases, this follicle or sac breaks open and releases an egg. But if the follicle doesn’t break open, the fluid inside the follicle can form a cyst on the ovary.

Corpus luteum cysts
Follicle sacs typically dissolve after releasing an egg. But if the sac doesn’t dissolve and the opening of the follicle seals, additional fluid can develop inside the sac, and this accumulation of fluid causes a corpus luteum cyst.

Hemorrhagic cyst

A third type of functional cyst, which is common, is a Hemorrhagic cyst, which is also called a blood cyst, hematocele, and hematocyst. It occurs when a very small blood vessel in the wall of the cyst breaks, and the blood enters the cyst. Abdominal pain on one side of the body, often the right side, may be present. The bleeding may occur quickly, and rapidly stretch the covering of the ovary, causing pain. As the blood collects within the ovary, clots form which can be seen on a sonogram. Occasionally hemorrhagic cysts can rupture, with blood entering the abdominal cavity. No blood is seen out of the vagina. If a cyst ruptures, it is usually very painful. Hemorrhagic cysts that rupture are less common. Most hemorrhagic cysts are self-limiting; some need surgical intervention. Even if a hemorrhagic cyst ruptures, in many cases it resolves without surgery. Patients who don’t require surgery will experience pain for 4 – 10 days after, and may require several days rest. Studies have found that women on tetracycline antibiotics recover 25% earlier than the majority of patients, a surprising correlation found in 2004. Sometimes surgery is necessary, such as a laparoscopy (“belly-button surgery” that uses small tools inserted through one or more tiny slits in the abdomen).

Dermoid cyst 

Endometrioid cyst

An endometrioma, endometrioid cyst, endometrial cyst, or chocolate cyst is caused by endometriosis, and formed when a tiny patch of endometrial tissue (the mucous membrane that makes up the inner layer of the uterine wall) bleeds, sloughs off, becomes transplanted, and grows and enlarges inside the ovaries. As the blood builds up over months and years, it turns brown. When it ruptures, the material spills over into the pelvis and onto the surface of the uterus, bladder, bowel, and the corresponding spaces between. Treatment for endometriosis can be medical or surgical. Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently used first in patients with pelvic pain, particularly if the diagnosis of endometriosis has not been definitively established. The goal of directed medical treatment is to achieve an anovulatory state. Typically, this is achieved initially using hormonal contraception. This can also be accomplished with progestational agents (i.e., medroxyprogesterone), danazol, gestrinone, or gonadotropin-releasing hormone agonists (GnRH), as well as other less well-known agents. These agents are generally used if oral contraceptives and NSAIDs are ineffective. GnRH can be combined with estrogen and progestogen (add-back therapy) without loss of efficacy but with fewer hypoestrogenic symptoms. Laparoscopic surgical approaches include ablation of implants, lysis of adhesions, removal of endometriomas, uterosacral nerve ablation, and presacral neurectomy. They frequently require surgical removal. Conservative surgery can be performed to preserve fertility in young patients. Laparoscopic surgery provides pain relief and improved fertility over diagnostic laparoscopy without surgery. Definitive surgery is a hysterectomy and bilateral oophorectomy.

Pathological cysts

Other cysts are pathological, such as those found in polycystic ovary syndrome, or those associated with tumors.

A polycystic-appearing ovary is diagnosed based on its enlarged size — usually twice normal —with small cysts present around the outside of the ovary. It can be found in “normal” women, and in women with endocrine disorders. An ultrasound is used to view the ovary in diagnosing the condition. Polycystic-appearing ovary is different from the polycystic ovarian syndrome, which includes other symptoms in addition to the presence of ovarian cysts, and involves metabolic and cardiovascular risks linked to insulin resistance. These risks include increased glucose tolerance, type 2 diabetes, and high blood pressure. Polycystic ovarian syndrome is associated with infertility, abnormal bleeding, increased incidences of pregnancy loss, and pregnancy-related complications. Polycystic ovarian syndrome is extremely common, is thought to occur in 4-7% of women of reproductive age, and is associated with an increased risk for endometrial cancer. More tests than an ultrasound alone are required to diagnose polycystic ovarian syndrome.

Symptoms of an ovarian cyst :

Abdominal bloating or swelling
Painful bowel movements
Pelvic pain before or during the menstrual cycle
Painful intercourse
Pain in the lower back or thighs
Breast tenderness
Nausea and vomiting

Severe symptoms of an ovarian cyst that require immediate medical attention include:
Severe or sharp pelvic pain
Fever
Faintness or dizziness
Rapid breathing

These symptoms can indicate a ruptured cyst or an ovarian torsion. Both complications can have serious consequences if not treated early.

Treatment :

Birth control pills
If you have recurrent ovarian cysts, your doctor can prescribe oral contraceptives to stop ovulation and prevent the development of new cysts. Oral contraceptives can also reduce your risk of ovarian cancer. The risk of ovarian cancer is higher in postmenopausal women.

Laparoscopy
If your cyst is small and results from an imaging test to rule out cancer, your doctor can perform a laparoscopy to surgically remove the cyst. The procedure involves your doctor making a tiny incision near your navel and then inserting a small instrument into your abdomen to remove the cyst.

Laparotomy
If you have a large cyst, your doctor can surgically remove the cyst through a large incision in your abdomen. They’ll conduct an immediate biopsy, and if they determine that the cyst is cancerous, they may perform a hysterectomy to remove your ovaries and uterus.

Cysts that persist beyond two or three menstrual cycles, or occur in post-menopausal women, may indicate more serious disease and should be investigated through ultrasonography and laparoscopy, especially in cases where family members have had ovarian cancer. Such cysts may require surgical biopsy. Additionally, a blood test may be taken before surgery to check for elevated CA-125, a tumor marker, which is often found in increased levels in ovarian cancer, although it can also be elevated by other conditions resulting in a large number of false positives.

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