Ovarian Cysts
Ovarian cysts are mostly benign changes that occur cyclically during the pre-menopausal period and reflect the hormonal activity of the ovary.
This is a normal occurrence where follicles (small cysts) reach a size of up to 30 mm and then rupture, releasing the egg cell (ovulation). Cysts can be functional and disappear in the next cycle, or they can bleed internally and rupture, which can lead to more severe bleeding in the abdomen that occasionally needs to be stopped surgically, through laparoscopy.
Among cysts that do not disappear, the most common are teratomas (dermoids) and chocolate cysts (endometriomas).
Dermoid Cysts
contain fatty tissue, hair, thyroid tissue, and teeth. These cysts usually do not cause problems and are mostly discovered incidentally, often only during a routine ultrasound examination in early pregnancy.
Teratomas can destroy the ovary with their growth and reduce ovarian reserve. Very rarely, in 1-3% of cases, they can undergo malignant transformation.
The most common complication with ovarian teratoma is its twisting or torsion, where the ovary rotates around its axis, reducing blood flow through the vessels that nourish it. If the torsion progresses, it can lead to complete interruption of blood supply (ischemia), resulting in ovarian necrosis. A precise ultrasound examination is very important in diagnosing torsion.
Treatment
Treatment of teratomas is performed laparoscopically, where the cyst is enucleated, and the ovary is sutured and thus preserved.
Endometriomas or Chocolate Ovarian Cysts
are often discovered incidentally during a routine ultrasound examination. The decision on treatment depends on the patient’s wishes regarding conception and any associated problems.
If the endometrioma is painful to touch and less mobile, and the patient also experiences pain during sexual intercourse, we must also consider the possibility of associated deep infiltrating endometriosis. Endometriomas are often surrounded by adhesions that prevent their torsion.
In post-menopause, serous and mucinous ovarian cysts are more common, which are also mostly benign.
Treatment
We remove endometriomas laparoscopically, enucleating the cyst and removing it from the abdominal cavity in a specially designed bag, thus preventing the contents from spilling inside the abdominal cavity.
