Ovarian Cyst Surgery in Chennai: When Is Surgery Really Necessary?

Ovarian cyst surgery — quick answers

Do all ovarian cysts need surgery?

No. Most cysts are functional cysts that form during a normal cycle and resolve within two to three months without any treatment. Surgery is needed for only a small minority.

When is ovarian cyst surgery necessary?

When the cyst is large (usually over 5 to 7 cm), persists beyond three months, causes ongoing pain, has solid areas or other suspicious features on ultrasound, twists (torsion), ruptures with bleeding, or when blood markers raise concern about cancer.

Is ovarian cyst surgery a major operation?

Usually not. Most cysts are removed by laparoscopy (keyhole surgery) through three or four small cuts, with a hospital stay of one day and recovery in one to two weeks.

Will I lose my ovary?

Rarely. In a cystectomy only the cyst wall is removed and the ovary is preserved, which is the standard approach in women who have not completed their family. Removing the whole ovary is reserved for suspected cancer or an ovary that is no longer viable.

Can an ovarian cyst be cancer?

In women before menopause, well over 90 percent of ovarian cysts are benign. The risk rises after menopause, which is why cysts found at that age are assessed more carefully.

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An ovarian cyst is a fluid-filled sac on or inside the ovary. Cysts are extremely common and most women will have one at some point, usually without ever knowing. Being told you have a cyst on a scan is therefore not, in itself, a reason to plan surgery. The decision rests on the type of cyst, its size and behaviour, your symptoms and your age.

Cysts that can safely be watched

Functional cysts (follicular and corpus luteum cysts) form as part of ovulation. They are thin-walled, filled with clear fluid, usually under 5 cm and go away on their own. The standard advice is a repeat ultrasound after six to twelve weeks. If the cyst has gone, nothing more is needed.

Small simple cysts with no solid parts in a woman of reproductive age are also managed by observation, even if they take a little longer to resolve.

Cysts that usually need surgery

• Size. Cysts larger than about 5 to 7 cm are less likely to resolve and more likely to twist or rupture.
• Persistence. A cyst that is still present, or growing, after three months of observation.
• Symptoms. Persistent pelvic pain, pressure on the bladder or bowel, or pain during intercourse that does not settle.
• Ultrasound features. Thick walls, solid areas, internal septations or increased blood flow suggest a cyst that will not disappear and needs to be removed and examined.
• Endometriomas (chocolate cysts) that are large, painful or affecting fertility.
• Dermoid cysts (mature teratomas), which do not resolve and carry a risk of torsion.
• Post-menopausal cysts that are complex or growing, because the possibility of cancer must be excluded.

Emergencies: when surgery cannot wait

Two situations need urgent surgery, often the same day:

Ovarian torsion. The cyst makes the ovary heavy enough to twist on its blood supply. It causes sudden, severe one-sided lower abdominal pain, often with vomiting. The ovary can be saved if it is untwisted within hours.

Ruptured cyst with bleeding. Most ruptures cause pain that settles with rest and painkillers, but a rupture with significant internal bleeding, dizziness or a fast pulse needs emergency laparoscopy.

How the surgery is done

Laparoscopic cystectomy is the standard operation. Under general anaesthesia, three or four cuts of 5 to 10 mm are made in the abdomen, the cyst is carefully separated from the healthy ovarian tissue and removed in a bag, and the ovary is left in place to keep working. Patients go home the same or next day and are back to normal activity in one to two weeks. The removed cyst is always sent for examination under the microscope.

Open surgery (laparotomy) is now uncommon and reserved for very large cysts or when cancer is suspected and the cyst must be removed intact.

Ovarian cysts and fertility

Removing a cyst by laparoscopy does not harm fertility when done with care to preserve ovarian tissue. In fact, removing large endometriomas or cysts that distort the ovary can improve it. If you are planning IVF, tell your surgeon, because the amount of ovarian tissue preserved matters and sometimes the cyst is best left alone until after treatment.

The bottom line

Watch the cysts that will go away on their own; operate on the ones that will not, that hurt, or that look suspicious. A gynaecologist experienced in laparoscopy can tell you which is which from a good ultrasound and, when needed, blood tests.

At Iswarya Hospital in OMR, Chennai, our gynaecology team assesses ovarian cysts with high-resolution ultrasound and offers laparoscopic cystectomy that preserves the ovary, with a 24×7 emergency service for torsion and rupture.