Bikini vs midline incision for large ovarian cyst

(UK)

I have a very large ovarian cyst and will need it removed surgically. I believe it will either be a midline or bikini incision, but I would like to get a second opinion to help me choose between the two.

I am 23, no children, normal weight. I have been very healthy until now and this is my first serious medical encounter. I am on the Yasmin p pill, never smoked, drink very little. No history of cysts in my family.

I was diagnosed with the ovarian cyst a month ago, but it has been going on for almost a year. No pain although there is some discomfort, mainly due to the size.

Everything points to it being benign, according to the ultrasound it is filled with fluid and the two blood tests came back normal.

I dont know which ovary is affected yet as it was too big to see on the ultra sound. I have yet to get the results of the CT scan.

I would be very unhappy if I had to get the midline incision, but the surgeon normally does it that way. Would it be unwise to refuse having the midline incision, assuming there is no medical reason why it should be impossible to have the bikini one? Should it be possible to remove a cyst through a bikini incision no matter what size the cyst is? Surely it should be possible to drain it to eliminate the size issue? Would keyhole surgery be realistic?

I dont want a badly visible scar for the rest of my life unless there is a really good reason for it, just because the surgeon normally does it that way.

Ovarian Cyst Surgery

Im not a surgeon and so my advice here is limited. I have done gynaecology as part of my medical training and am fully aware that cysts can be absolutely massive. Your cyst sounds as though it is pretty big and must be occupying a large space if the ultrasound cant distinguish whether it is arising from the left or right ovary.

Turning to whether the surgery should be performed via a midline incision or a bikini incision, this is a technical decision that only your surgeon can make. If you are unhappy with this, you can always ask for a second opinion at the hospital you attend.

As to whether the cyst can be drained or not, it isn’t something normally undertaken for a variety of reasons. Cysts, when drained, usually reform and have to be removed to prevent this. Fluid within a cyst can be very viscous and difficult to drain. Sometimes very large cysts are dermoid cysts. These can contain not only fluid, but bits of hair, teeth and other tissues too and can’t be drained. Finally, there is always concern about cancer formation and removing the cyst would be curative and also can be fully checked to make sure there isn’t any evidence of this. Good luck!




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