Management of Ovarian Cysts: Current Approaches and Impact of Surgical Hemostasis on Ovarian Reserve

Abstract

Background: Ovarian cysts are common gynecological conditions that affect females across different age groups. Their management depends on several factors, including cyst type, size, sonographic appearance, symptom severity, patient age, menopausal status, fertility wishes, and the possibility of malignancy. Most simple functional cysts in reproductive-age women resolve spontaneously and can be managed conservatively with clinical and ultrasonographic follow-up. Medical treatment is mainly directed toward symptom relief and prevention of recurrence, whereas surgery is indicated for persistent, enlarging, symptomatic, complicated, or suspicious ovarian cysts. Laparoscopic cystectomy is currently preferred for most benign ovarian cysts because it provides faster recovery, less postoperative pain, shorter hospital stay, and better cosmetic outcomes than laparotomy. However, preservation of ovarian reserve remains a major concern, particularly during hemostasis after cystectomy. Bipolar electrocoagulation provides rapid and effective bleeding control but may cause thermal damage to healthy ovarian tissue, while suturing may better preserve ovarian reserve despite being technically more demanding. This review summarizes the conservative, medical, and surgical management of ovarian cysts, with particular emphasis on laparoscopic cystectomy and the comparative effects of bipolar coagulation and suturing on ovarian reserve.