MANAGEMENT OF OVARIAN CYSTS

The management of an adnexal masses involves several steps: - establish the diagnosis of organic ovarian cyst, avoiding an useless and iatrogenic surgery of a functional cyst, knowing that functional cysts may persist more than 3 months and may occur even on low-dose oral contraceptives; - cure painful cysts, by ultrasound guided aspiration of some functional cysts or laparoscopic detorsion of twisted adnexae; - exclude malignancy, with the help of ultrasound, Doppler and Ca-125 preoperatively, then laparoscopic examination and pathology; failed diagnosis of cancer becomes rare (I out of 360 laparoscopic surgeries for ovarian cyst); the association of a benign ultrasound and Doppler pattern and of a Ca-125 lower than 35 mUI / ml is almost pathognomonic of a benign cyst; - cure benign ovarian cysts with a minimum of surgical trauma; in our series, 84,4 % of ovarian cysts are managed laparoscopically, 11,1 % by elective laparotomy, 4,5 % by laparotomy after an attempt at laparoscopic surgery (that implies that the patient must be informed of the risk of laparotomy); - adapt the surgical technique to the pathologic type and size of the cyst, with a high rate of laparotomy in large dermoid cysts, and a high rate of (salpingo-)oophorectomy in peri or postmenopausal cysts; - ensure an adequate therapy of early ovarian carcinomas, avoiding understadification and undertreatment; - prevent ovarian cancer by a careful long-term follow-up of patients with benign ovarian cysts and by the use of bilateral oophorectomy in postmenopausal patients.