Chocolate Cyst Removal

Chocolate Cyst Removal

Numerous women have inquired about what is a chocolate cyst? Also referred to as an endometrioma, it is one of various kinds of cysts on ovaries that occur in women. A chocolate cyst is a pouch or sac on the ovary filled with fluids and sometimes semi-solid substance as well, in which event it can be termed a complex ovarian cyst. Since the endometrial tissue within the cyst is sensitive to monthly hormones it bleeds and fills the lining of such cysts with unclotted blood. Chocolate cysts owe their name to the dark, old blood which grossly appears like chocolate. Chocolate cyst is also known as endometrial cyst, endometrioma cyst, and chocolate ovarian cyst.

How are chocolate cysts formed?

A woman with the disease endometriosis will develop tissue from the inside lining of her uterus (endometrium) grow onto the ovary.

• The islands of endometrial cells can develop tiny cysts which proliferate into still more cysts when they are stimulated by menstrual hormones.
• As the cysts migrate they become part of the ovary itself, replacing the normal ovulatory tissue.
• Inflammation and irritation of adjacent organs can be caused by chocolate cysts migrating throughout the pelvic cavity.
• Endometriomas will be experienced by millions of women every year.
• Five to ten percent of all females will develop one at some time in their life, most often during their reproductive years.
• One of the key issues with chocolate cysts is that they will often recur.
• Typically, the diameter of an endometrioma is anywhere from half an inch (grape size) to four inches or larger (softball size).

Pregnancy and Infertility with Chocolate Cysts

Most women want to know whether a chocolate cyst will cause or hinder pregnancy. A woman can still become pregnant even if she does not have the endometrioma removed. The reply is less certain in advanced instances where many cysts co-exist and there are more than a few inches in size. But laparoscopy sure boost the rate of pregnancy. Pregnancy has been reported with 50% incidence in 3 years following therapy in certain series. Again, the rate of conception is optimized within the span of a six-month time after successful management and recovery of the ovaries. Ultimately, the patient's health and desires for childbearing will be significant factors in planning a successful pregnancy.

Chocolate Cysts Symptoms

The symptoms of chocolate cyst are as like endometriosis symptoms because the basic disease is same. Some other diseases imitate this disease like ovarian cyst symptoms, pcos symptoms, and ectopic pregnancy. All women may not experience the same symptoms. Actually, some might have very bad symptoms while others might have none. The severity and extent of symptoms do not always match the progression of the disease.

Abdominal cramping or bloating in a menstrual cycle is an extremely common symptom for women with endometriomas. Another potential indication of a cyst is increasingly painful menses. Pain can also be experienced while emptying the bladder or bowels. Sex and other physical activities like exercising or bending and stretching can be painful.

Rupture of the ovary chocolate cyst will also cause severe pain. When a ruptured chocolate cyst leaks its contents onto the pelvis organs and ovaries, it can lead to adhesions (scarring), infection, or severe pelvic pain. A ruptured ovarian cyst is an emergency medical condition and you need to do something immediately if you experience symptoms of heavy bleeding, fever, vomiting or worse pain.

Bleeding outside the regular menstrual cycle is also a sign of endometriomas. A woman could find that she is bleeding at unusual times or spotting between the periods. Women who are post-menopausal and experience bleeding from the vagina should also consider the possibility of a cyst being present. There is also the possibility of increased bleeding and discharge from the vagina that is darker in color.

Objective

• Dysmenorrohea, Dysparenunia & pelvic pain & Infertility are the presenting symptoms.
• Chocolate cysts can be detected in Infertility patient during trance vaginal USG evaluation.
• Endometriosis is the most common cause of Infertility during Laparoscopy.
• Most rewarding outcomes are obtained after Laparoscopic surgery with pregnancy rate of 50 to 70% in various series for chocolate cyst with Endometriosis.
• Cystectomy must be chosen in place of simple drainage for avoiding recurrence.
• But if we think cystectomy dissection is too tough & will kill lots of normal ovarian follicles, we do drainage & bipolar fulguration of internal surface of chocolate cyst (based on serum AMH Level).
• asdfRectovaginal endometriosis is meticulously assessed during Laparoscopy. Right cleavage & correct dissection of recto-vaginal nodule for her relief from pain is of prime importance.b

Advantages of Laparoscopy Surgery

Laparoscopy is sole option in chocolate cyst. Laparoscopy provide 10-time magnification and much closer vision to operate.

• Less Hospital stays.
• Early return to your regular work.
• Cosmetically very small scar.
• Less pain post operation.
• Optimum fertility improvement & Fertility outcomes after Laparoscopy.
• No. Of Cuts on Abdomen---Three cuts: all of 5 mm size.
• Average Stay in Hospital---14 to 26 hours. (DAY CARE SURGERY)
• Average Duration of Surgery---For routine Laparoscopy procedure will take only 25 to 75 minutes. For complicated Endometriosis it will take 1-2 hours
• Average Blood loss during Operation---50-100 cc.
• Average time to return to normal activities/work after operation---Most patients are treated with

Laparoscopy as Day care procedure, going home within 24 hours of the operation. Most people feel much better within one day.

Anesthesia

General Anesthesia (Patient will not experience any pain in Operation Theatre during surgery)

Post-operative Course

Patient feels drowsy/sedated for 2-3 hours following laparoscopy but conscious & not painful.

• Patient is allowed fluids after 3-4 hours following laparoscopy and light food following 6-8 hours. -She can be uncomfortable with a little abdominal and shoulder pain post-laparoscopy for 24-48 hours, but it cam be relieved using pain killer tablets.
• The majority of the patients can walk like normal without needing any support and can have regular diet 12 hours following laparoscopy.
• She can be discharged on the following day of the operation.
• Minimal patients might experience nausea & vomiting after laparoscopy, which can be well managed with injection in post-operative room.
• Patient can resume her normal activity within 24 hours of laparoscopy. Patient is advised to take antibiotics & analgesic tabs. For 5 days after laparoscopy.
• Patient advised to come to doctor for severe pain or bleeding or temperature in postoperative period (Day-1 to Day-5) immediately.
• Patient advised to visit for follow-up after 7 days from the Laparoscopy for dressing.

Dr. Kapil Kanade has already performed more than 450 Chocolate Cysts Surgery Successfully. He has extensive experience in conducting successful Chocolate Cysts surgery throughout Maharashtra.

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