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Ovarian Cystectomy and Reconstruction

Ovarian cysts are fluid-filled sacs that form on or within the ovary. Most are benign (non-cancerous), but some may cause pain, pressure, bloating, or disrupt the ovary’s normal function. When necessary, I offer ovarian cystectomy — surgical removal of the cyst while preserving healthy ovarian tissue — often done via minimally invasive laparoscopy.

For people who are of reproductive age, the goal is almost always to preserve the ovary unless removal is clearly in your best interest. I routinely perform reconstructive techniques to restore the shape and function of the ovary after cyst removal.

Why might I need this surgery?

Cyst removal may be recommended if:

  • The cyst is large, growing, or persistent
  • It’s causing pain, bloating, or pressure
  • Imaging suggests the cyst may be borderline or malignant
  • It’s affecting ovarian function or fertility
  • There’s a risk of torsion (twisting of the ovary)
  • It doesn’t resolve after several menstrual cycles
  • You’ve had multiple or recurrent cysts

Types of ovarian cysts

Most cysts are benign, but it’s important to get a proper diagnosis. Common types include:

  • Functional cysts (follicular or corpus luteum) – often resolve on their own
  • Dermoid cysts – made up of different tissue types, often require removal
  • Endometriomas – “chocolate cysts” associated with endometriosis
  • Cystadenomas – fluid-filled, may become large
  • Haemorrhagic cysts – blood-filled, usually resolve but may rupture

What happens during surgery?

Most ovarian cystectomies are performed laparoscopically, meaning through tiny cuts using a camera and specialised instruments. This typically involves:

  1. A small incision at your belly button and two or three low-abdominal incisions
  2. Careful dissection of the cyst away from healthy ovarian tissue
  3. Reconstruction of the ovary using fine sutures to restore shape and blood supply
  4. Removal of the cyst, usually placed in a containment bag to prevent fluid spillage

If the ovary is very damaged, or if malignancy is suspected, a salpingo-oophorectomy (removal of ovary and tube) may be discussed, but this is rare in younger patients unless clearly necessary.

Recovery and downtime

Recovery after laparoscopic cystectomy is usually quick and straightforward:

  • Most people go home the same day
  • You can expect some abdominal bloating and tiredness for a few days
  • Most return to light activity within 1–2 weeks, and full activity by 4 weeks
  • Pain is usually mild and can be managed with simple pain relief

It’s common to have spotting or menstrual changes for a cycle or two post-op.

Preserving your fertility

Ovarian cyst surgery can feel stressful — especially if you’re concerned about fertility. My surgical approach is always ovary-sparing wherever possible, and I take extra care to preserve egg reserve and blood supply.

I use pre-operative transvaginal ultrasound to assess the cyst type and ovary health in detail, which allows for better planning. If you’re planning a family (now or later), we’ll discuss how this procedure fits into your broader fertility goals.

Is it cancer?

Most ovarian cysts are not cancer, especially in people under 40. I use detailed ultrasound features, blood tests (e.g. CA-125, CA19-9 if needed), and your history to assess risk. If there are any concerns, I will involve a gynaecological oncologist.

Risks and complications

As with any surgery, there are risks. These include:

  • Bleeding, infection, or injury to nearby organs (e.g. bowel, bladder)
  • Recurrence of the cyst
  • Adhesion (scar tissue) formation
  • Rarely, loss of the ovary

These are uncommon, especially when surgery is performed by an experienced laparoscopic gynaecologist.

Dr Sam Holford

Let’s talk about it

If you you have an ovarian cyst — or are experiencing pelvic pain — let’s figure out what’s going on together. Not all cysts need surgery, but when they do, I’m here to guide you through with a kind, evidence-based approach.

Book an appointment

FAQs

Will I lose my ovary if I have a cystectomy?
The goal of an ovarian cystectomy is to remove only the cyst while preserving the healthy parts of your ovary. In the vast majority of cases, the ovary is carefully reconstructed and left in place. Ovary removal (oophorectomy) is only considered if the ovary is too damaged to save or if there is a concern about cancer.
Will having an ovarian cyst removed affect my fertility?
Preserving fertility is a top priority. By carefully removing the cyst and reconstructing the ovary, the aim is to protect your ovarian reserve (egg supply). In many cases, removing a large or problematic cyst can actually improve ovarian function and fertility.
How do I know if my ovarian cyst is cancerous?
Most ovarian cysts, especially in premenopausal people, are benign (not cancerous). We assess the risk using a detailed ultrasound scan, your symptoms, and sometimes blood tests. The cyst is sent to the lab after removal for a definitive diagnosis.
What is the recovery like after a laparoscopic ovarian cystectomy?
Recovery is usually quick. Most people go home the same day and can return to light activities within 1-2 weeks. You should avoid heavy lifting and strenuous exercise for about 4 weeks. It’s normal to have some bloating and mild discomfort for a few days.
Can ovarian cysts come back after surgery?
It is possible for new cysts to form on the ovaries in the future, particularly functional cysts related to your menstrual cycle or endometriomas if you have endometriosis. However, the specific cyst that was removed will not return.

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Please note: This information is general in nature and not a substitute for medical advice tailored to your specific situation.