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Benign diseases of Ovaries Management

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Benign diseases of Ovaries Management

  1. 1. Benign Tumors of Ovaries Management Mehtab Sami Final Year MBBS
  2. 2. 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     
  3. 3. 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 
  4. 4. Patients aged 35-45 years:  Treated on individual basis.  Benign cyst<5cm,and wish for uterus conservation: conservative mgt.  Larger cyst+completed family: surgery 
  5. 5. 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 
  6. 6. Symptomatic Patients  Emergency laparotomy or laparoscopy irrespective of size of tumor or age of patient. 
  7. 7. Treatment Therapeutic ultrasound guided cyst aspiration  Laparoscopy  Laparotomy 
  8. 8. 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  
  9. 9. 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
  10. 10.  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
  11. 11. 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 
  12. 12. 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. 
  13. 13. 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. 

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