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Dr. Andrew Rynne

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Exp 50 years

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I need consultation from a very XXXXXXX & experienced doctor

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Dr. Shanti Vennam

OBGYN

Practicing since :1989

Answered : 7372 Questions

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Posted on Fri, 21 Dec 2018 in Vaginal and Uterus Health
Question: I need consultation from a very XXXXXXX & experienced doctor in this field, preferably from an XXXXXXX Gyane Doctor.

During her annual health Check-up at XXXXXXX Hospital XXXXXXX (all medical report done on end week of August 2018 & 1st week of September 2018 with heading of XXXXXXX Hospital Enclosed), she was detected with a cyst. Please refer USG report. We then took appointment of Dr Zarin XXXXXXX of Same hospital (attached at page 12 & 13 of 15) , she prescribed some contraceptive pills Oval L. Which she took for few days , but since there was some side -effects , doctor changed the medicine Cobadex forte, which she took regularly. On 7th Sept , we again done a confirmatory USG which is also enclosed from XXXXXXX All report of Biochemistry including CA125, AFP, PAP smear enclosed.

On 29.11.2018, we again had a repeat USG after completion of course of contraceptive medicine from Dr J Khamaru (Mediscan) enclosed.

i) My query is what is to be done now ?
ii_) Whether to go for Laparoscopic Surgery now or wait.
iii)Problem is that We have two years old kid who can not stay without his mother & in case of her confinement due to Lap Surgery, I dont know how to manage.
iv) Whether there are specialist like Gyane Laparoscopic Surgeon or they will be general lap surgery.
v) Will there may be issue to conceive in case lap surgery is done ?
vi) Is there still chances to redevelop cyst after lap surgery.
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Follow up: Dr. Shanti Vennam 0 minute later
I need consultation from a very XXXXXXX & experienced doctor in this field, preferably from an XXXXXXX Gyane Doctor.

During her annual health Check-up at XXXXXXX Hospital XXXXXXX (all medical report done on end week of August 2018 & 1st week of September 2018 with heading of XXXXXXX Hospital Enclosed), she was detected with a cyst. Please refer USG report. We then took appointment of Dr Zarin XXXXXXX of Same hospital (attached at page 12 & 13 of 15) , she prescribed some contraceptive pills Oval L. Which she took for few days , but since there was some side -effects , doctor changed the medicine Cobadex forte, which she took regularly. On 7th Sept , we again done a confirmatory USG which is also enclosed from XXXXXXX All report of Biochemistry including CA125, AFP, PAP smear enclosed.

On 29.11.2018, we again had a repeat USG after completion of course of contraceptive medicine from Dr J Khamaru (Mediscan) enclosed.

i) My query is what is to be done now ?
ii_) Whether to go for Laparoscopic Surgery now or wait.
iii)Problem is that We have two years old kid who can not stay without his mother & in case of her confinement due to Lap Surgery, I dont know how to manage.
iv) Whether there are specialist like Gyane Laparoscopic Surgeon or they will be general lap surgery.
v) Will there may be issue to conceive in case lap surgery is done ?
vi) Is there still chances to redevelop cyst after lap surgery.
doctor
Answered by Dr. Shanti Vennam 1 hour later
Brief Answer:
Detailed below.

Detailed Answer:
Hello,

Thanks for trusting us with your health concern.

I have gone through your query and also the attached reports.

Here are your answers:

1. From the reports, I observe that the cyst is a complex one, above 5 cm. in size and there is a rise in AFP, which is seen with embryonic tumors, which can be a dermoid cyst in this situation. Therefore, I suggest removal of the cyst and get it biopsied to plan further management. This is not malignancy, it is a benign tumor, but needs to be removed.

2. You better go for the laparoscopy now since the cyst is showing a tendency to increase in size as later on removal through laparoscopy may become cumbersome.

3. Most often, recovery is quicker with laparoscopy. Though, I would suggest avoiding lifting weights for a few weeks. She can resume normal work in a week or two depending on her recovery. Meanwhile, you may have to make sure the child is attended by a person as close as his mother.

4. The surgery can be performed by a gynecologist who does laparoscopy or a general surgeon who specializes in laparoscopic surgeries. You can choose the best in your area.

5. With a clean surgery and no postoperative issues, future conception is not a problem.

6. The chances of recurrence are 4 percent with laparoscopy and 0 percent with laparotomy as per reports.

Hope I have clarified your queries. Please feel free to contact for further information. I will be happy to help.

regards,
Shanti.V.
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
doctor
Answered by Dr. Shanti Vennam 0 minute later
Brief Answer:
Detailed below.

Detailed Answer:
Hello,

Thanks for trusting us with your health concern.

I have gone through your query and also the attached reports.

Here are your answers:

1. From the reports, I observe that the cyst is a complex one, above 5 cm. in size and there is a rise in AFP, which is seen with embryonic tumors, which can be a dermoid cyst in this situation. Therefore, I suggest removal of the cyst and get it biopsied to plan further management. This is not malignancy, it is a benign tumor, but needs to be removed.

2. You better go for the laparoscopy now since the cyst is showing a tendency to increase in size as later on removal through laparoscopy may become cumbersome.

3. Most often, recovery is quicker with laparoscopy. Though, I would suggest avoiding lifting weights for a few weeks. She can resume normal work in a week or two depending on her recovery. Meanwhile, you may have to make sure the child is attended by a person as close as his mother.

4. The surgery can be performed by a gynecologist who does laparoscopy or a general surgeon who specializes in laparoscopic surgeries. You can choose the best in your area.

5. With a clean surgery and no postoperative issues, future conception is not a problem.

6. The chances of recurrence are 4 percent with laparoscopy and 0 percent with laparotomy as per reports.

Hope I have clarified your queries. Please feel free to contact for further information. I will be happy to help.

regards,
Shanti.V.
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Shanti Vennam 39 hours later
1) What may be the reason for development of this Ovary Cyst ? Since, my wife had ceasarian sectional delivery 02 year back, is this cyst developed due to ceasarian surgery did not go perfectly ?

2) Please note that my wife does not have any other Gynae problem, no pain at lower abdomen, period is more or less at regular interval. Hence, since we are having some family compulsion in near days, we are planning to do Laporoscopic surgery in XXXXXXX 2019 at Apollo XXXXXXX Will it be safe to wait till that time ?

3) Is there any medicine to take now ?

4) Upto what size of Ovarian cyst , Lap surgery can be done comfortably ?

5) Can you please recommend a very GOOD doctor based on XXXXXXX Apollo or XXXXXXX Apollo , who are "Gyane Doctor having expertise in Lap Surgery"

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Follow up: Dr. Shanti Vennam 0 minute later
1) What may be the reason for development of this Ovary Cyst ? Since, my wife had ceasarian sectional delivery 02 year back, is this cyst developed due to ceasarian surgery did not go perfectly ?

2) Please note that my wife does not have any other Gynae problem, no pain at lower abdomen, period is more or less at regular interval. Hence, since we are having some family compulsion in near days, we are planning to do Laporoscopic surgery in XXXXXXX 2019 at Apollo XXXXXXX Will it be safe to wait till that time ?

3) Is there any medicine to take now ?

4) Upto what size of Ovarian cyst , Lap surgery can be done comfortably ?

5) Can you please recommend a very GOOD doctor based on XXXXXXX Apollo or XXXXXXX Apollo , who are "Gyane Doctor having expertise in Lap Surgery"

doctor
Answered by Dr. Shanti Vennam 9 hours later
Brief Answer:
Detailed below.

Detailed Answer:
Hello,

Thanks for writing back. Very sorry for not being able to give a prompt reply.

After going through your queries, I would like to offer some information.

Here are your answers:
1. Dermoid cyst is not due to improper surgical procedure. It is an embryonic one, that is, it is present through the fetal stage and in the ovary, it is most commonly observed during the reproductive age. There are a few cells which remain in the embryonic state and capable of growing into several structures like teeth, hair, nails etc., which are the usual contents of a dermoid cyst. These cysts can occur anywhere in the body.

2. You can safely take your time before proceeding for further management. These cysts are a chance finding during sonography and often not associated with any symptoms. In fact, though surgery was the only treatment of choice in earlier days, of late, expectant management is also being tried. This means surgery is performed in conditions where the cyst is likely to cause complications either due to its size etc., when the patient opts for it to avoid repeated visits, in women with many children irrespective of age and in the older patients. In the rest, there is a regular follow up to monitor the cyst, its growth and any possible complications like torsion, infection, rupture etc., which call for surgery.

This is not a cyst that influences the hormone state and hence, there are no associated menstrual disturbances.

3. There is no need of any medication now specifically for the treatment.

4. Commonly, a cyst of size less than or equal to 5 cm. is preferably removed through laparoscopy. However, cysts of 15 cm. size also have been successfully removed through laparoscopy. This is possible when the nature of the tumor is not suspected to be malignant and the surgical expertise available is good. The risks of cyst rupture and spillage during laparoscopy make laparotomy preferred by some, especially when the nature of the cyst in unknown, which is not your case.

5. I cannot recommend a doctor as such, since I do not have much information and also because of the protocols usually followed, you may have to visit a gynecologist initially for coordinated management and later follow up.

Hope I have provided the required information. Please do contact for any other clarifications. I will be ready to help.

regards,
Shanti.V.
Above answer was peer-reviewed by : Dr. Prasad
doctor
doctor
Answered by Dr. Shanti Vennam 0 minute later
Brief Answer:
Detailed below.

Detailed Answer:
Hello,

Thanks for writing back. Very sorry for not being able to give a prompt reply.

After going through your queries, I would like to offer some information.

Here are your answers:
1. Dermoid cyst is not due to improper surgical procedure. It is an embryonic one, that is, it is present through the fetal stage and in the ovary, it is most commonly observed during the reproductive age. There are a few cells which remain in the embryonic state and capable of growing into several structures like teeth, hair, nails etc., which are the usual contents of a dermoid cyst. These cysts can occur anywhere in the body.

2. You can safely take your time before proceeding for further management. These cysts are a chance finding during sonography and often not associated with any symptoms. In fact, though surgery was the only treatment of choice in earlier days, of late, expectant management is also being tried. This means surgery is performed in conditions where the cyst is likely to cause complications either due to its size etc., when the patient opts for it to avoid repeated visits, in women with many children irrespective of age and in the older patients. In the rest, there is a regular follow up to monitor the cyst, its growth and any possible complications like torsion, infection, rupture etc., which call for surgery.

This is not a cyst that influences the hormone state and hence, there are no associated menstrual disturbances.

3. There is no need of any medication now specifically for the treatment.

4. Commonly, a cyst of size less than or equal to 5 cm. is preferably removed through laparoscopy. However, cysts of 15 cm. size also have been successfully removed through laparoscopy. This is possible when the nature of the tumor is not suspected to be malignant and the surgical expertise available is good. The risks of cyst rupture and spillage during laparoscopy make laparotomy preferred by some, especially when the nature of the cyst in unknown, which is not your case.

5. I cannot recommend a doctor as such, since I do not have much information and also because of the protocols usually followed, you may have to visit a gynecologist initially for coordinated management and later follow up.

Hope I have provided the required information. Please do contact for any other clarifications. I will be ready to help.

regards,
Shanti.V.
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Shanti Vennam 45 hours later
As per your advice , we have taken an appointment for surgical removal of ovarian cyst at apollo XXXXXXX Doctor's consulation is on 18.12.2018, most like surgery may be done on 19.12.2018 or on 20.12.2018.

But one issue just arrived that my wife has due for menstrural bleeding on 16.12.2018 (expected)

My query is whether there will be any issue in lap surgery during above menstrural period ?
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Follow up: Dr. Shanti Vennam 0 minute later
As per your advice , we have taken an appointment for surgical removal of ovarian cyst at apollo XXXXXXX Doctor's consulation is on 18.12.2018, most like surgery may be done on 19.12.2018 or on 20.12.2018.

But one issue just arrived that my wife has due for menstrural bleeding on 16.12.2018 (expected)

My query is whether there will be any issue in lap surgery during above menstrural period ?
doctor
Answered by Dr. Shanti Vennam 1 hour later
Brief Answer:
Menstruation does not influence the surgery.

Detailed Answer:
Hello,

Thanks for letting me know your thoughts.

Menstruation does not influence the surgery. Also, if she receives her period as scheduled, by the time of the surgery, the menstrual flow should reduce and as such, should not give her much discomfort.

The procedure can be performed as scheduled. There is no need to postpone the menstrual cycle.

Hope I have clarified your query. Please get back if you need anything else.

regards,
Shanti.V.
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
doctor
Answered by Dr. Shanti Vennam 0 minute later
Brief Answer:
Menstruation does not influence the surgery.

Detailed Answer:
Hello,

Thanks for letting me know your thoughts.

Menstruation does not influence the surgery. Also, if she receives her period as scheduled, by the time of the surgery, the menstrual flow should reduce and as such, should not give her much discomfort.

The procedure can be performed as scheduled. There is no need to postpone the menstrual cycle.

Hope I have clarified your query. Please get back if you need anything else.

regards,
Shanti.V.
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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