Surgery for giant ovarian tumors
Giant cystomas (mucinous and serous cystadenomas) occupy the entire abdominal cavity, compress the intestines, diaphragm and blood vessels, stretch the abdominal wall and are often fused with the omentum; repeated surgery is complicated by scars and adhesions. After a longitudinal incision, the surgeon isolates the surgical field,, if necessary, evacuates the contents of the cyst in doses (slowly to avoid a sharp drop in pressure), removes the tumor with an appendage, resects the fused part of the omentum, carries out urgent histology and revision, and then restores the abdominal wall with suturing of the diastasis and, if necessary, mesh reinforcement. Preoperative preparation includes CT scan, tumor markers, heart and lung assessment; after surgery - bandage for 2 months, prevention of thrombosis, histology control with a gynecological oncologist.
Indications
- cysts and benign tumors of the ovaries of large sizes (more than 10–15 cm), not subject to laparoscopy;
- suspicion of a borderline or malignant tumor - the need for revision and urgent histology;
- pronounced adhesions, repeated operations, concomitant diseases that exclude laparoscopy;
- giant cystomas involving the omentum and stretching of the abdominal wall.
Open surgery for cysts
Laparotomy for ovarian cysts is used today for very large and suspicious formations: open access allows you to remove the entire tumor without rupture (essentially in case of possible malignancy), examine and palpate all organs, perform an urgent histological examination and, if necessary, expand the volume. In young women, ovarian tissue is preserved as much as possible; In case of a unilateral tumor, the second ovary must be examined. The bikini incision is sutured cosmetically.
When to choose laparotomy
Open access through a transverse Pfannenstiel incision (along the bikini line) remains the method of choice for very large sizes of the uterus and formations, multiple fibroids with deep nodes, severe adhesions after many operations, suspected malignancy with the need for revision, severe heart and lung diseases in which pneumoperitoneum is undesirable, as well as when laparoscopy is unavailable. Laparotomy gives the surgeon direct control of the tissue and a reliable multi-layer suture on the uterus; the scar after cosmetic suturing is barely noticeable. Recovery is longer than after laparoscopy: hospital stay 3–6 days, exercise limitation 1.5–2 months.
