In surgeries for the treatment of benign ovarian diseases, it is generally recommended to preserve as much functional ovarian tissue as possible, for example, through a cystectomy or the removal of a solid tumor from the ovary. A complete oophorectomy is only considered when the ovarian tissue can no longer be preserved or attempts to preserve the tissue are not sufficiently successful.
Aspiration and Fenestration versus Ovarian Cystectomy
Aspiration of cyst contents:
- Not recommended: No tissue for histopathology, cytology of cyst fluid unreliable for exclusion of malignancy.
- Recurrence rate: Up to 65%.
- Complication rate: 2.6%.
- Comparison: No better outcomes than simple observation.
Fenestration:
- Method: Removal of a full-thickness, square part of the cyst wall to create a window.
- Problems less frequent: Compared to aspiration.
- Risk in malignant cysts: Spillage of malignant cells into the peritoneal cavity possible.
- Cystectomy still preferred
Cystectomy:
- Preferred procedure: For the treatment of benign ovarian cysts.
Sclerotherapy after aspiration:
- Method: Injection of methotrexate, tetracycline, alcohol, or erythromycin after aspiration.
- Recurrence rate: 4 to 38% in cyst persistence or recurrence.
- Uncertainty: Efficacy compared to expectant management not sufficiently controlled.
Reference:
- Zanetta G, Lissoni A, Torri V, et al. Role of puncture and aspiration in expectant management of simple ovarian cysts: a randomized study. BMJ 1996; 313:1110.
- Díaz de la Noval B, Rodríguez Suárez MJ, Fernández Ferrera CB, et al. Transvaginal Ultrasound-Guided Fine-Needle Aspiration of Adnexal Cysts With a Low Risk of Malignancy: Our Experience and Recommendations. J Ultrasound Med 2020; 39:1787.
- Mesogitis S, Daskalakis G, Pilalis A, et al. Management of ovarian cysts with aspiration and methotrexate injection. Radiology 2005; 235:668.