Introduction
Ovariectomy, the surgical removal of one or both ovaries, is performed for various reasons, such as treating ovarian cancer, preventing ovarian cysts, or managing hormonal conditions. Although ovariectomy is generally safe, potential complications can occur after the surgery. This article offers a brief overview of the potential complications that may arise following ovariectomy surgery, providing readers with a concise summary of the associated post-operative risks.
What Is Ovariectomy?
Ovariectomy is a surgical procedure to remove one or both ovaries from a woman's reproductive system. It is also called oophorectomy and is performed to treat various conditions, including large ovarian cysts, chronic pelvic pain, ectopic pregnancy, benign tumors, and pelvic inflammatory disease. It can help manage severe endometriosis and reduce the risk of ovarian and breast cancer risk. The fallopian tubes may be removed with the ovaries to reduce ovarian cancer risk. Before surgery, the patient undergoes physical examination, urine and blood tests, and imaging tests like ultrasound and CT(Computed tomography) scan.
How Is Ovariectomy Performed?
Ovariectomy can be performed using various techniques. The patient is first anesthetized with general anesthesia. The surgical approach depends on the patient's situation. The options include open abdominal surgery, laparoscopic procedure, and robotic surgery. There are different approaches to performing ovariectomy. Open abdominal surgery involves making an incision in the abdomen to remove the ovaries.
In contrast, laparoscopic surgery utilizes small abdominal holes and a camera and light source for guidance during removal. Robotic surgery also involves small abdominal holes but with the assistance of a robotic arm for precise visualization and removal of the organ. Each technique has its advantages and is chosen accordingly.
What Are the Indications for Ovariectomy?
People with ovarian cancer, cysts, benign tumors, abscesses or pelvic infection, endometriosis, ectopic pregnancy, or ovarian torsion are generally eligible for ovariectomy. Women with a higher risk of breast cancer and BRCA gene mutations are also eligible for this ovariectomy treatment.
What Are the Contra-indications for Ovariectomy?
Women in the premenopausal phase who wish to conceive should consult with a physician before considering ovariectomy. Surgical approaches like open abdominal surgery, laparoscopic procedure, or robotic surgery are based on the person's specific circumstances. This technique provides many advantages and depends on the patient's requirements.
What Are the Potential Side Effects of Ovariectomy?
Side effects of ovariectomy can be infection, allergic to anesthesia, bleeding, blood clots, and damage to other nearby organs. The symptoms the patient experiences after the surgery due to the side effects are vaginal dryness, hot flashes, anxiety and depression, and changes in sex drive. Serious complications can be faced if the patient is obese, has diabetes, or is a smoker.
What Are the Post-treatment Guidelines?
After undergoing open abdominal surgery, it is typically advised to remain in the hospital for approximately two to three days under the careful observation of a doctor. It is important to avoid applying creams or lotions on the incision sites. Once the patient regains consciousness from anesthesia, they are encouraged to engage in slow walking to prevent the formation of blood clots. It is also recommended to refrain from lifting heavy objects following the surgery.
How Long Does It Take to Recover?
After laparoscopic surgery, patients need about two weeks to recover before returning to their everyday work routine. In contrast, open abdominal surgery may require a more extended recovery period of six weeks or even more for complete healing. There can be valid reasons to consider this procedure for a woman's well-being when it comes to removing the ovaries. Whether partially or entirely, the decision to undergo ovariectomy must weigh the potential risks to ensure an informed choice.
What Are the Post-surgical Complications of Ovariectomy?
Surgical Site Infections:
Surgical site infection is the most frequent complication that can occur after ovariectomy. These infections may arise from bacteria introduced during the surgery or insufficient wound care post-surgery. Symptoms such as redness, swelling, pain, or discharge at the incision site may indicate an infection. Adhering to sterile techniques during the procedure and providing diligent wound care can help reduce the risk of infection.
Mortality:
Women undergoing oophorectomy face a higher long-term mortality risk from all causes, except for those with high-risk BRCA gene mutations. The risk is mainly for women who have their ovaries removed before 45 years. However, this increased risk does not only affect younger age groups; it also impacts overall survival rates. The increased risk is primarily associated with deaths from hormonal changes, cardiovascular disease, and hip fractures leading to death. Even when a hysterectomy is performed simultaneously, the long-term survival rate tends to be better for women who do not have their ovaries removed.
Menopausal Symptoms:
When bilateral oophorectomy is performed, the ovaries cease the production of natural estrogen and progesterone, leading to an abrupt onset of surgical menopause. Unlike the gradual transition of natural menopause, surgical menopause occurs abruptly. The symptoms experienced during this phase, including hot flashes, mood swings, and vaginal dryness, can be more intense. Hormone replacement therapy is often considered a management option to alleviate these symptoms and enhance overall well-being.
Cardiovascular Risk:
There is a significant risk of cardiovascular disease, which is seven times higher in women who undergo oophorectomy than women who choose to retain their ovaries. The process is not entirely clear, yet it is believed that it is due to hormonal fluctuations after the surgery. Although used to mitigate these changes, hormone replacement therapy cannot fully replicate the natural hormone production of the ovaries. The ovaries are vital in producing hormones at varying levels throughout a woman's life, tailored to her needs. Without their functioning, the impact on a woman's body, including the increased risk of cardiovascular issues, becomes evident.
Osteoporosis:
Oophorectomy can cause several consequences due to sudden hormonal changes. One significant problem is an increased chance of getting osteoporosis. This condition occurs when bone density declines due to reduced estrogen levels. This higher chance of osteoporosis is compounded by lower testosterone levels, which can cause a loss of height and weak bone density. To address these risks, non-hormonal medications like bisphosphonates can strengthen bones and decrease fracture chances.
Sexual Effects:
Oophorectomy can also affect a woman's sexual function. It can cause a decrease in libido, difficulties with sexual arousal, and vaginal dryness. Considering the potential risks involved, women are advised against doing oophorectomy unless necessary. Examining each woman's situation and making informed decisions based on their needs is essential.
Adhesion Formation:
After ovariectomy, there is a potential risk of adhesion formation within the pelvic cavity. Adhesions are strands of scar tissue that may develop between organs or between organs and the abdominal wall. It may cause pain, bowel obstructions, or fertility issues. Surgeons make many efforts to reduce adhesion formation during the surgical procedure. But still, adhesions form in some cases.
Hormonal Imbalance:
When the ovaries are removed, it can disrupt hormonal equilibrium, leading to menopausal symptoms like hot flashes, vaginal dryness, mood swings, and a decline in libido. To alleviate these symptoms and reduce the long-term impact of hormonal imbalances, physicians may suggest hormonal replacement therapy (HRT).
Hemorrhage:
During ovariectomy, severing and sealing of the blood vessels that nourish the ovaries is undertaken. Yet, excessive bleeding can occur during or after the surgery. This outcome can lead to complications such as hematoma (formation of a blood collection), anemia, or hypovolemic shock. Surgeons employ necessary precautions to control the bleeding during surgery to conquer this threat. It is crucial to identify and address any bleeding-related issues promptly.
Urinary Complications:
In rare cases, ovariectomy can cause urinary complications like urinary tract infections and urinary incontinence. These complications may occur due to surgical trauma to nearby structures. Hence, diagnosing and managing these problems is essential to prevent further complications and maintain optimal urinary function.
Conclusion
Like any surgery, Ovariectomy is a surgical procedure with potential risks and complications. However, with proper surgical techniques, care, and attentive post-operative monitoring, the severity and occurrence of complications can be minimized. It leads to a smoother recovery for patients. Hence, patients and healthcare professionals must be conscious of these potential risks and implement necessary measures to ensure the best possible outcomes and a healthy lifestyle.
