The ovary is the organ that houses egg cells in women. The formations occurring in the ovary are called cysts. Most of the ovarian cysts are benign, but a small number have the potential to turn into cancer. When we say cyst, it has an outer wall or a pseudo-wall and its contents can generally be liquid, dense liquid substance, solid and semi-liquid-solid.
Ovarian Cysts: Simple Ovarian Cysts, Mucinous Cyst, Endometriosis Cyst (Chocolate Cyst), There are different types such as dermoid cyst and fibroma. In simple ovarian cysts, the fluid inside the cyst is clear and its inner surface is smooth. In mucinous cysts, the interior of the cyst sometimes consists of honeycomb-like compartments and the fluid inside is in the form of dense clear jelly. In chocolate cyst, the fluid inside the cyst is like melted chocolate. Dermiod cysts are cysts formed in the ovaries by residues from embryonic life, that is, while in the womb. Inside the dermioid cyst, there are tissue residues of hair, teeth, fat fragments and sometimes organs such as the thyroid. In cysts called fibromas, the cyst is completely filled and hard.
Diagnosis of Ovarian Cysts
Ovarian cysts generally manifest themselves with groin pain, abdominal swelling and lower back pain. Sometimes it is diagnosed accidentally during a gynecological examination without any symptoms. The most important tool in diagnosis is ultrasonography. Ultrasonographic findings provide information about the type and size of the cyst as well as its potential for cancer. The larger the cyst size in ultrasonography, the thicker the fluid inside it and the more vascularity it has in Doppler examination, the higher the risk of cancer. Additionally, there is a risk of cancer if additional fluid has accumulated in the abdomen during ultrasonography.
In addition to ultrasonography and color Doppler findings, blood tests and ovarian cancer markers are also examined, the main ones being Ca12-5, CEA, Ca15-3, B-hCG and AFP. is. Especially Ca12-5 2 times or more than the normal value increases the suspicion of ovarian cancer. However, the important point that should not be forgotten is that Ca12-5 can be high in many normal situations and sometimes in other problems.
The most important of these is menstrual bleeding. Ca12-5 is high during menstruation and menstruation should not be checked when requested in ovarian cysts. I. It may also increase in infections in the abdomen, kidney failure, pancreasitis and liver problems.
If there are obvious cancer findings in Ovarian Cysts, then a whole abdominal tomography or MRI examination may be required. The aim here is to determine the prevalence of the disease. Since our subject is benign cysts, MRI and tomography are unnecessary. Ultrasonography and Doppler provide sufficient information.
Treatment and Follow-up Methods According to the Type of Ovarian Cysts:
1. In simple ovarian cysts, a significant part of them can disappear with ultrasonography performed after 1-2 periods.
2. Removal of ovarian cysts or removal of the ovary with open surgery
3. Removal of ovarian cysts or removal of the ovary with laparoscopy
4 Withdrawal of ovarian cyst fluid? It is a method used in very special cases and has a high probability of recurrence.
Treatment of Ovarian Cysts with Laparoscopy
Removing cysts in the ovaries with laparoscopy has now become standard practice. Removing benign cysts by laparoscopy, after being evaluated beforehand, is an operation that takes 30 to 60 minutes, depending on the size of the cyst and the condition of the adhesions in the abdomen. Cyst removal by laparoscopy is a procedure performed under general anesthesia. The abdomen is entered through a total of 3 holes called trocars, under the navel and on both sides of the groin. First of all, the uterus, ovaries and tubes are checked. The procedure begins after the surrounding organs and intestines are examined. If there is intact ovarian tissue, the cyst is stripped from the ovary and its wall is removed. If there is no intact ovarian tissue, sometimes the entire ovary may need to be removed. If the cyst has not ruptured after removing the cyst with its wall, it is placed in bags called endobags and its fluid is removed, and after its size is reduced, it is taken out of the abdomen. If the cyst bursts, its wall is placed in a bag and taken out. As for the remaining ovarian tissue, the bleeding foci are burned and after the bleeding is stopped, it is washed with intra-abdominal fluid and the procedure is terminated. Sometimes, if the remaining ovarian tissue looks very messy, it can be joined with stitches.
3 hours after the ovarian operation with laparoscopy, the first food intake and standing up and walking is done. Surgery is allowed and our patient can be discharged home after 5-6 hours. Our patient can return to work within 5-6 days after the operation.
Success in ovarian cyst surgery with laparoscopic surgery is parallel to the experience of the surgeon performing the procedure and the quality of the instruments used. Good equipment shortens surgery time, reduces trauma and the patient has less pain.
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