Ovarian cyst removal: when surgery is needed, risks and recovery

An ovarian cyst is a fluid-filled sac on an ovary. Many are found by chance and cause nothing. The NHS notes that problems usually arise only if a cyst bursts, grows very large or twists, and that sudden severe pelvic pain, or abdominal pain with nausea or vomiting, needs urgent help through NHS 111 or A&E.

For the majority of cysts the plan is watchful waiting with repeat ultrasound scans. The NHS adds that people past the menopause are monitored more closely, with scans and blood tests at intervals, because ovarian cancer is more likely at that age. Removal is considered when the cyst is large, persists, causes symptoms, or has features that make cancer possible.

Because a cyst can recur, removing one does not rule out future ones. For endometriosis cysts or dermoid cysts the reasoning is different, and a surgeon will explain why a specific type is unlikely to settle.

Assessment usually includes a vaginal or pelvic ultrasound and may include blood tests such as tumour markers or an MRI if the appearance is unclear. These results determine whether the surgery is done by a general gynaecologist or involves a cancer specialist team.

Hospital instructions on fasting and medicines apply. If you are premenopausal, a pregnancy test is checked, and you may be asked to use contraception beforehand. Discuss fertility plans openly because they shape how much of the ovary is conserved.

• Bring a list of medicines and tell the team about blood thinners.

• Ask who will be doing the operation and whether a specialist is available if the cyst looks unusual.

• Arrange a lift home and someone to stay for the first night.

In a keyhole cystectomy a few small cuts are made in the tummy and the surgeon separates the cyst from the surrounding ovary, usually keeping the healthy tissue. The cyst is placed in a bag and drawn out so its contents do not spill. The tissue is sent for examination.

The NHS describes laparotomy, one larger cut, for particularly large cysts or when cancer is suspected, and this means a longer stay of several days. Sometimes the whole ovary has to be removed if it cannot be saved, for instance if it has twisted and lost its blood supply; consent should cover that.

General anaesthetic is used. Keyhole patients are normally awake and eating within hours.

General laparoscopy leaflets list infection, bleeding, injury to the bowel, bladder or blood vessels, clots in the leg and hernia at a cut. The Plymouth leaflet gives about 1 in 200 for injury to nearby organs and about 1 in 1,000 for conversion to open surgery in gynaecological laparoscopy generally; these figures are not specific to cyst removal.

Cyst-specific points are that the cyst may be found to be something other than expected, that a cyst can return, and that taking cyst tissue from the ovary can affect the egg supply in that ovary, which is why ovary-sparing technique is a priority.

After keyhole surgery the NHS says most people go home the same or next day. Expect tummy soreness, bloating and shoulder-tip pain from the gas for a day or two; simple painkillers usually suffice. Leaflets for other keyhole gynaecology operations give return to work after about five days up to two to three weeks depending on the work, and your surgeon will say which applies.

After an open operation recovery is longer and lifting and driving are restricted for more weeks. GOV.UK reminds drivers to ask their doctor if unsure and to inform the DVLA if still unable to drive three months after surgery.

• Sudden severe pelvic pain, or pain with nausea and vomiting: NHS 111 or A&E.

• Fever, heavy bleeding, unusual discharge or an infected-looking scar: GP or the hospital.

• A swollen, red calf, chest pain or breathlessness: 999 if severe.

• What type of cyst do you think I have, and what makes surgery better than waiting?

• Will you try to save the ovary, and in what situation would you remove it?

• Is there any reason to involve a cancer team?

• What follow-up scans will I need?

The surgery is the same. NHS pathways often involve an initial period of watching with repeat scans before surgery is offered, which suits many cysts, whereas private care may be quicker to schedule if you and your surgeon agree surgery is needed. In either setting, ask about the arrangements for tissue results and for follow-up.