How is surgery for chocolate cysts performed?

There are generally two surgical approaches for chocolate cysts: 1. Traditional open abdominal surgery: Combined spinal-epidural anesthesia is used, and the patient is placed in a supine position. A longitudinal incision of about 10 cm is made in the mid-lower abdomen, and the layers are dissected down to the ovary. Under direct visualization, the cystic tissue is excised, followed by peritoneal lavage. The incision is then closed layer by layer using absorbable sutures. Postoperatively, a drainage tube and urinary catheter are left in place, and antibiotics are administered to prevent infection. 2. Laparoscopic surgery: General anesthesia is used, with the patient in a supine position. A 1-cm incision is made at the umbilicus to establish a pneumoperitoneum, and a laparoscope is inserted to visualize the cyst. Additional punctures are made at other abdominal sites for further assessment of the intra-abdominal condition. The cyst is separated from surrounding adhesions and stripped away; hemostasis is achieved either by suturing or using an electrocautery device depending on the bleeding. Postoperatively, a drainage tube and urinary catheter are similarly placed, and antibiotics are given to prevent infection.