Ovarian cyst removal

Published by Bupa's Health Information Team, July 2010.

This factsheet is for women who are planning to have ovarian cysts removed, or who would like information about it.

Ovarian cysts are fluid-filled sacs (pockets) that can occur inside or on the surface of your ovaries. They may be removed if they are causing pain, a build up of pressure, or are suspected of being cancerous.

You will meet the surgeon carrying out your procedure to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.

About ovarian cyst removal

There are different types of ovarian cyst. More than nine in ten are benign (non-cancerous) and they are rarely malignant (cancerous). You may need surgery to remove ovarian cysts if they are:

• suspected of being cancerous
  
• causing pain (because of twisting or bleeding)
  
• large and causing a build up of pressure, or pressing up on your bladder or other organs

What are the alternatives?

If the cysts aren't causing any symptoms, your surgeon may suggest 'watchful waiting' for a period of one to two months. This means your surgeon may monitor any changes in size with ultrasound scans and will determine whether you need further tests or treatment. Most cysts, however, go away on their own.

Preparing for ovarian cyst removal

Your gynaecologist (a doctor who specialises in women's reproductive health) will explain how to prepare for your operation. For example, if you smoke, you will be asked to stop as smoking increases your risk of getting a chest and wound infection, which can slow your recovery.

You will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it's important to follow your anaesthetist or surgeon's advice.

You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs. You may need to have an injection of anticlotting medicine called heparin as well as, or instead of, wearing compression stockings.

Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

What happens during ovarian cyst removal?

Ovarian cysts are usually removed as a keyhole procedure (in which small instruments and a tube-like telescopic camera are inserted through small cuts in your abdomen to perform the operation). You will probably be able to go home the same day as your operation, or after a short overnight stay in hospital. The cuts in your skin will be closed with dissolvable stitches.

Very rarely, your surgeon may need to convert a keyhole procedure to open surgery (your surgeon will make a single, large cut into your abdomen to reach your ovary). This may be because of technical difficulties during the operation or an unexpected finding, for example the cysts may appear malignant. You may need to stay in hospital overnight.

The operation your surgeon will advise you to have will depend on many factors. These may include the type and size of the cyst, how severe your symptoms are, your age and general health.

What to expect afterwards

You will need to rest until the effects of the anaesthetic have passed. You may need pain relief to help with any discomfort as the anaesthetic wears off.

If you have had open surgery, you may have a catheter to drain urine from your bladder into a bag.

General anaesthesia temporarily affects your co-ordination and reasoning skills, so you must not drink alcohol, operate machinery or sign legal documents for 48 hours afterwards.

You will usually be able to go home when you feel ready. Your nurse will give you some advice about caring for your healing wounds before you go home. You may be given a date for a follow-up appointment.

The length of time your dissolvable stitches will take to disappear depends on what type you have. However, for this procedure they should usually disappear in about two to three weeks.

Recovering from ovarian cyst removal

It usually takes about one to two weeks to recover from ovarian cyst removal, but this varies between individuals, so it's important to follow your surgeon's advice.

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

What are the risks?

Ovarian cyst removal is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.

Side-effects

These are the unwanted but mostly temporary effects you may get after having the procedure.

After keyhole surgery, you may have some pain in your abdomen and in the tips of your shoulders. The pain in your shoulders is known as referred pain and usually improves within 48 hours.

Complications

This is when problems occur during or after the operation. The possible complications of any operation include an unexpected reaction to the anaesthetic, infection, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT).

Specific complications of ovarian cyst removal are rare but can include:

• removal of one or both of your ovaries (a procedure known as oophorectomy), if the cysts are malignant or have caused irreversible damage
• accidental damage to other organs in your abdomen (such as your bowel, bladder or major blood vessels)
• damage to your fallopian tube, or tubes - this may increase your risk of ectopic pregnancy or infertility
• damage to your womb - this can lead to bleeding and infection, and may require further surgery or, extremely rarely, a hysterectomy

You may develop an infection after surgery. Symptoms of infection can include:

• severe lower abdominal pain or swelling
• high temperature
• dark or unpleasant smelling vaginal discharge
• unpleasant smelling discharge coming from your belly button, with pain and swelling around the area

You should contact your GP if you develop any of these symptoms.

The exact risks are specific to you and differ for every person, so we have not included statistics here. Ask your surgeon to explain how these risks apply to you.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.