Introduction. Functional cysts represent the most frequent ovarian mas ses in childrens and adolescents. Management of ovarian cysts is dependent on the features of the cysts at ultrasonography and the pre-sence of symptoms. The aim of the study was to evaluate surgical ap-proach used in the management of ovarian mass in the pediatric and ado lescent population. Materials and methods. We prospectively re-viewed the cases of ovarian masses in children in our institution over a fifteen-year period, which included 200 patients (age ≤18 years). Results. The mean age of patients was 15.6±0.2 years (range: 8-18 years). It was diagnosed a significantly higher rate of unilateral mass compared with bilateral ovarian lesions (93% vs. 7%, p<0.001). Diagnostic USG was done in all patients and all of those images had a mean mass size max. 8.23±0.28 cm (95% CI: 7.6-8.8) and min 7.1±0.5 cm (95% CI: 6.08-8.1). Over 136 (68%) surgical procedure were performed via laparotomy and 63 (31.5%) via laparoscopy (in one case was performed conversion to laparotomy; 0.5%). The ovarian-preserving surgery was the significant predominant procedure (n=178, 82.7%, p<0.001). In thirty-seven cases (17.2%) were performed: salpingo-oophorectomy (n=28), oophorectomy (n=8) and subtotal hysterectomy with bilateral adnexectomy (n=1). His-to pathological report revealed: simple cyst (n=128, 59.25%), ovar ian dermoid cyst (n=38, 17.6%), cystadenoma (n=36, 16.67%), en do me trio-ma (n=7, 3.24%), hydatid cyst (n=2, 0.92%), fibroma (n=2, 0.92%), and granulosa-theca cell tumor (n=3, 1.4%). Conclusion. The fertility-spa-ring surgery should be the preferred surgical approach for children and ado les cents with maximal preservation of ovarian tissue for later sexual de ve lop ment and it shouldn’t compromise the future fertility.