Endometrioma, also known as chocolate cysts, are cystic structures that usually appear in the ovaries and contain cells belonging to the endometrium layer that covers the inside of the uterus. The disease is popularly known as chocolate cyst due to the color it takes from the fluid inside the cysts.

Causes of Chocolate Cyst

Although the cause of chocolate cyst is not known exactly, risk factors can be listed as follows:

• Retrograde menstruation (shedding of endometrial cells mixed with blood spilled during menstruation into the abdomen by going back through the fallopian tubes)
• Genetic factors
• Estrogen hormone
• Cesarean
• Surgical history
• Immune system problems

Chocolate Cyst Symptoms

Although some of the chocolate cysts do not cause any pain, they occur incidentally as a result of examinations such as ultrasound and MRI. Symptoms of chocolate cysts:

• Painful or irregular menstruation
• Pain during sexual intercourse
• Pain in the abdomen, lower back, or pelvic area
• Infertility
• Excessive bleeding
• Pain during urination or defecation
• Intestinal problems

Surgery in the Treatment of Chocolate Cyst

The treatment of chocolate cysts, or endometriosis as they are called in medicine, is usually done by individualizing the patients. In the case of chocolate cyst, if the condition that bothers the patient is pain, a treatment plan should be made to eliminate the pain. If the problem is the inability to get pregnancy even though there is a desire to get pregnant, a treatment plan should be made for it.

In the case of endometrioma or endometriosis (the presence of endometrial cell foci other than cysts), although medical treatment is used to relief pain, surgical intervention is also an effective and frequently used treatment method in the treatment of pain. More aggressive surgeries such as opening the adhesions due to the chocolate cyst with the surgical procedure, removing the cysts and cleaning the surrounding area, cutting the pain-transmitting nerves in the groin area in even more severe and common cases, and removing the part affected by the cysts in the intestinal wall (segmental resection) are performed according to the course of the patient and the disease.

In the treatment of chocolate cysts or endometriosis, surgical operation can be performed either open (laparotomy) or closed (laparoscopy; procedure by entering the abdomen with a camera and surgical instruments). The purpose of surgical operations for chocolate cysts is to remove all of the cysts (recurs if the cyst is not completely removed), to destroy the foci of endometriosis, and to open the adhesions if there are adhesions.

In cases of chocolate cysts, laparoscopic surgery should be preferred primarily in surgical intervention. However, in special cases, laparotomy, that is, open surgery, may be required.

Although open surgery carries more risks due to the larger incision, blood loss is higher and the recovery time is longer, it can be applied in some cases.

Open surgical method is used to remove cysts that cannot be removed by laparoscopic method or in very large sizes.

The laparoscopic procedure is usually performed by opening a 10-millimeter hole from the navel and several 5 mm holes in the lower abdomen and removing the cysts with the help of a camera and surgical instruments. The advantages of closed (laparoscopic) surgeries over open (laparotomy) surgeries are that the procedure is performed with less blood loss, the length of hospital stay and the time to return to daily life are short. In addition, the fact that the patient has previously undergone a surgical procedure through the abdomen is usually not a problem that prevents the patient from having closed surgery.