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ovarian cyst surgery
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ovarian cyst surgery

Hello

I have a question regarding adhesions following ovarian cystectomy.
I am a 33 years old female with 6 to 7 cm right ovarian cyst.  Sonogram shows it is a multiple cyst.

4 years ago I had a 3cm right ovarian cyst which ruptured. It damaged one of my blood vessels.
I came to OR through emergency and was operated on for 4.5 hours, (not laparoscopic surgery), there was Peritonitis, acute pain and abdominal cavity bleeding. I had blood transfusion. The lab showed cyst being benign.
Now the story repeats itself. But the cyst is twice as big. The same surgeon recomends to operate laparotomicaly with small inscision.
She does not want to do laparoscopy because she is afraid that  due to my previuos surgery I might have adhesions. Plus the mass she feels during pelvic exam seems to be stuck. She says if we start laparoscopy we may do more damage, therefore we should go with laparotomic exploration.  She is also afraid the cyst may spill if we do laparoscopy.
Another GYN doctor recommended I do not do laparotomy  because it may lead to complications and adheasions. Specifically because I had a previous surgery. He says, at least start with laparoscoppy, and then decide further….

Can someone help me in making the descision. What do I choose? please

My CA 125 is elevated to 47, I am a bit aneamic. The rest seems to be normal.

Thank you,

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Dear Dina,
thank you for your complete information.  In general, the surgeon who has already seen the inside of your body has the best knowledge with which to base a decision about surgical approach.  It may be that looking first with laparoscopy is reasonable. However the complication rate for laparoscopy is twice the complication rate of laparotomy. Complications include injury to the bowel, bladder, ureter(the tube that brings the urine form the kidney to the bladder), and blood vessels.

There is also the risk of an unrecognized injury at laparoscopy. That is - the surgeon puts a trocar ( a narrow tube with a sharp edge) through the abdominal wall and into the abdominal (peritoneal ) cavity. It is possible to poke through bowel going in and not see this because the surgeon is looking through the trocar and cannot see around the trocar.

Adhesions can occur because of the process that causes the cyst (such as peritonitis or endometriosis. Adhesions can also occur from surgery as well.

Ultimately, you should go with the doctor whom you trust and whose approach makes sense to you.

I hope everything works out
best wishes
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