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Benign diseases of Ovaries Management
 

Benign diseases of Ovaries Management

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    Benign diseases of Ovaries Management Benign diseases of Ovaries Management Presentation Transcript

    • Benign Tumors of Ovaries Management Mehtab Sami Final Year MBBS
    • Management Asymptomatic Patients Patients less than 35 years More likely to be benign. Treat conservatively Criteria for observtion:  Patient under 35  Unilateral tumor  Unilocular cyst  No solid component  Tumor size less than 10cm  Ascites absent     
    • Cyst under 3cm:no management  Cyst 4-10cm:USG every 8 weeks  If cyst fails to reduce in size or if initial size>10cm:Laparoscopy or Laparotomy 
    • Patients aged 35-45 years:  Treated on individual basis.  Benign cyst<5cm,and wish for uterus conservation: conservative mgt.  Larger cyst+completed family: surgery 
    • Patients above 45 years:  Early recourse to surgery is beneficial.  Criteria for conservative mgt:  Simple unilateral cyst<3cm  CA 125 levels < 35µ/ml  Normal vascular resistance pattern 
    • Symptomatic Patients  Emergency laparotomy or laparoscopy irrespective of size of tumor or age of patient. 
    • Treatment Therapeutic ultrasound guided cyst aspiration  Laparoscopy  Laparotomy 
    • Therapeutic ultrasound guided cyst aspiration Has a high recurrence rate Candidate:  Young woman  Unilateral  Unilocular  Anechoic  Thin walled cyst  Less than 10cm in dia  Contraindications:  Solid tumor  Symptomatic patient  
    • Laparoscopy   Indications:  Doubt about the nature of lesion  Cyst suitable for lap surgery(simple ovarian cyst without solid component,benign cystic teratoma)  Patients < 35 years Procedures:  Aspiration and fenestration  Cystectomy  Oophorectomy  Salpingo-oophorectomy
    •  Disadvantages:  Spillage of cyst contents  Incomplete excision of cyst wall  Unexpected dx of malignancy  Inadequate tm of malignancy discovered by chance at laparoscopy  High recurrence rate
    • Laparotomy  Indications: Persistent cyst  Symptomatic tumor  Solid tumor  Tumor with solid component  In case of laparoscopic complication  Suspected malignancy  Acute abdomen:emergency laparotomy  Procedures:  Cystectomy  Unilateral salpingo-oophorectomy  TAH+BSO  Omentectomy 
    • Pregnant female Asymptomatic ovarian cyst:  Managed conservatively  Should NOT be removed in 1st trimester  Simple cysts<10cm:conservative mgt+regular USG  Must be observed carefully during puerperium as dermoid cysts can undergo torsion.  If cyst persists 6 weeks post partum:surgery. 
    • Symptomatic ovarian cyst:  Sugery is the treatment of choice regardless of size of cyst or duration of gestation.  Suspected malignancy: Caesarian hysterectomy, BSO and omentectomy. 