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Ovarian cyst removal

Published by Bupa's health information team, June 2008.

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

There are two ovaries one on either side of your uterus (the womb), and their function is to develop eggs and produce female sex hormones. Ovarian cysts are fluid-filled sacs (pockets) that can occur inside or on the surface of the ovaries.

Your care will be adapted to meet your individual needs and may differ from what is described here. So it's important that you follow your surgeon's advice.

About ovarian cysts
Diagnosis of ovarian cysts
What are the alternatives?
Preparing for your operation
About the operation
What to expect afterwards
Recovering from ovarian cyst surgery
What are the risks?
Further information
Questions and answers
Related topics
Sources

About ovarian cysts

Ovarian cysts are quite common in women of childbearing age. You can develop a single cyst or many cysts and they can vary in size. Most ovarian cysts are harmless and don't cause any pain or discomfort. Some cysts, however, may cause a dull or sharp ache in the lower abdomen and pain during sexual intercourse. Surgery maybe recommended to:

confirm a diagnosis of ovarian cysts and rule out ovarian cancer
remove cysts that could cause pain or infertility (because of twisting or bleeding)
release pressure where, for example, large cysts are pressing on your bladder or other organs

Diagnosis of ovarian cysts

Your GP will ask about your symptoms and may request a pelvic ultrasound to help identify ovarian cysts. If the cyst is causing you severe discomfort, your GP will usually refer you to a gynaecologist (a surgeon specialising in women's reproductive health).

What are the alternatives?

If your cyst isn't causing any symptoms, your GP may suggest watchful waiting, especially if you are still having periods. Most cysts go away on their own after one or two menstrual cycles.

Preparing for your operation

Your surgeon 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.

Ovarian cysts are usually removed as a day case using keyhole procedure. This is usually done under general anaesthesia, which means you will be asleep during the operation.

You will be asked to follow fasting instructions. Typically you must not eat or drink for about six hours before a general anaesthetic. However, some anaesthetists allow occasional sips of water until two hours beforehand.

At the hospital, your nurse may check your heart rate and blood pressure, and test your urine.

Your surgeon will usually ask you to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.

You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs.

About the operation

The operation usually takes 30 to 45 minutes depending on the technique used.

Laparoscopic (keyhole) surgery

Two or three small cuts are made on your lower abdomen. Your surgeon will insert a tube-like telescopic camera to view the cysts. Your surgeon may also pass a metal instrument called a 'sound' through your cervix (neck of the womb). The cysts are cut and removed using specially designed surgical instruments passed through the other skin cuts. The skin cuts are closed with dissolvable stitches. For more information, please see the related Bupa health factsheet, Gynaecological laparoscopy.

Open surgery

Sometimes open surgery is needed. A cut is made either horizontally along the top of your 'bikini line' or vertically from just below your belly button to your 'bikini line'. The cyst is removed and the skin cut is closed with stitches. You may need to stay in hospital overnight.

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.

You may have a catheter to drain urine from your bladder into a bag. It's usually removed within 24 hours.

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.

You will need to arrange for someone to drive you home. You should try to have a friend or relative stay with you for the first 24 hours.

Recovering from ovarian cyst surgery

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.

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 shouldn't drive until you are confident that you could perform an emergency stop without discomfort. If you are in any doubt about driving, please contact your motor insurer so that you are aware of their recommendations, and always follow your surgeon's advice.

Take it easy for a day or two after returning home. You must not do any heavy lifting or strenuous exercise until you have made a full recovery.

Sexual intercourse can be resumed when you feel ready. You should continue to use your usual form of contraception unless advised otherwise.

If you develop any of the following symptoms contact your GP as you may have developed an infection:

heavy bleeding with large clots
severe lower abdominal pain or swelling
high temperature
dark or smelly vaginal discharge

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 of a successful procedure, for example feeling sick as a result of the general anaesthetic.

After keyhole surgery, you will have some pain in the abdomen and in the tips of your shoulders. The pain in your shoulders is known as referred pain and is due to irritation of the diaphragm above the stomach by the gas. This usually improves within 48 hours.

Complications

This is when problems occur during or after the operation. Most women are not affected. 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:

accidental damage to other organs in the abdomen (such as the bowel, bladder or major blood vessels) - extremely rarely, these complications can be fatal
oophorectomy - the ovary may need to be removed
damage to fallopian tube - this may increase your risk of ectopic pregnancy or infertility
damage to the womb - this can lead to bleeding and infection, and may require further surgery or, extremely rarely, a hysterectomy

There's a chance your surgeon may need to convert your keyhole procedure to open surgery.

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.

Further information

Royal College of Obstetricians and Gynaecologists
020 7772 6200
www.rcog.org.uk