How is surgery for chocolate cyst performed?

Sep 27, 2022 Source: Cainiu Health

Dr. Lv Aiming

Introduction

Laparoscopic surgery involves making trocar incisions at the umbilicus and around the abdominal area, including one-third and two-thirds of the distance from the umbilicus to the anterior superior iliac spine. A dissecting forceps is inserted into the pelvic cavity to locate the ovarian cyst. Once identified, the fluid within the endometrioma (chocolate cyst) is first drained. After drainage, the cyst cavity is irrigated to flush out blood remnants. Following irrigation, the endometrioma is carefully stripped away from the surrounding ovarian tissue.

Ovarian chocolate cyst surgery is determined based on the patient's age, fertility requirements, and the size and extent of invasion of the cyst. Currently, laparoscopic surgery is commonly used in clinical practice. The surgical procedure is as follows:

1. Anesthesia: The patient lies supine on the operating table and receives general anesthesia administered by a professional anesthesiologist;

2. Incisions: Small incisions are made at the navel and around the abdomen, including one-third and two-thirds of the distance from the anterior superior iliac spine;

3. Instrument insertion into the pelvic cavity: A dissection forceps is inserted into the pelvic cavity to locate the ovarian cyst;

4. Cyst剥离 (stripping): Once located, the cyst is first punctured to drain the fluid inside. After drainage, the cyst cavity is irrigated to remove blood residues, followed by careful stripping of the chocolate cyst;

5. Suturing and hemostasis: At the end of the procedure, blood within the pelvic cavity is flushed out. The surgeon checks for any abnormal bleeding. Once confirmed, instruments are withdrawn, concluding the operation.

It is recommended to seek treatment at a reputable hospital and undergo the procedure under the guidance of a qualified physician.

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Is the recurrence rate high after surgery for chocolate cysts?

The recurrence rate of chocolate cysts after surgery depends on the surgical approach. For patients who wish to preserve fertility, conservative surgery that preserves reproductive function is performed, but the postoperative recurrence rate is as high as approximately 40%. For symptomatic patients under 45 years old who do not desire fertility, surgery preserving ovarian function is conducted, with a recurrence rate of about 5%. For severe cases in patients over 45 years old, radical surgery involving removal of the lesions, uterus, and bilateral adnexa is performed, which prevents recurrence.

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Is it normal not to have menstruation after surgery for chocolate cyst?

Whether it is normal for menstruation not to resume after surgery for chocolate cyst depends on the individual's postoperative condition. If ovarian reserve function is good, menstruation typically returns about one month after surgery. However, if ovarian reserve function is poor and follicular recovery is slow, menstruation may resume in 2 to 3 months. If menstruation has not returned within 3 months after surgery, this is considered abnormal.

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What should one eat after surgery for a chocolate cyst?

It is advisable for patients to consume foods such as lean meat, eggs, milk, spinach, and apples after surgery for chocolate cysts. Additionally, medications such as dydrogesterone tablets, drospirenone and ethinylestradiol tablets, Guizhi Fuling pills, combined norethisterone tablets, and medroxyprogesterone acetate tablets may be used according to medical advice. Patients should also avoid consuming spicy, raw, cold, or greasy irritating foods after surgery, as these may affect wound healing and physical recovery.