This Video demonstrate Laparoscopic Management of Inclusion cyst with Bilateral Endometrioma. Peritoneal inclusion cyst (PIC) is defined as a fluid-filled mesothelial-lined cysts of the pelvis and it is most frequently encountered in women of reproductive age. The treatment options are observation, hormonal management, imaging-guided aspiration, image-guided sclerotherapy and surgical excision. Peritoneal inclusion cysts are uncommon abdominopelvic cysts seen in reproductive age group women. It is often misdiagnosed clinically as an ovarian tumor due to similar presentation and mimicking findings on radiology. We describe a woman presenting with pelvic mass. Her clinical finding on radiology suggested an ovarian tumor; however, biopsy revealed it as peritoneal inclusion cysts.

Peritoneal inclusion cysts (PICs) and bilateral endometriomas are complex gynecological conditions often associated with chronic pelvic pain, infertility, and recurrent pelvic adhesions. Advances in minimally invasive surgery have made laparoscopic management the gold standard for treating these conditions, offering excellent outcomes with minimal morbidity.

Understanding the Conditions
Peritoneal Inclusion Cyst

A peritoneal inclusion cyst is a benign fluid-filled collection formed when ovarian fluid becomes trapped by pelvic adhesions. These cysts commonly occur in women with a history of:

Pelvic inflammatory disease

Endometriosis

Previous abdominal or pelvic surgeries

Though benign, PICs can grow large and cause pelvic pain, pressure symptoms, and menstrual irregularities.

Bilateral Endometrioma

Endometriomas, often referred to as chocolate cysts, are ovarian cysts caused by endometriosis. When present in both ovaries, they are termed bilateral endometriomas. They may lead to:

Severe dysmenorrhea

Chronic pelvic pain

Infertility

Ovarian damage if left untreated

Role of Laparoscopic Surgery

Laparoscopy allows precise diagnosis and treatment of both conditions in a single surgical setting. It provides excellent visualization of pelvic anatomy and enables complete disease clearance while preserving ovarian function.

Surgical Technique

Key steps in laparoscopic management include:

Diagnostic Laparoscopy

Assessment of pelvic anatomy

Identification of peritoneal inclusion cysts, endometriomas, and adhesions

Adhesiolysis

Careful dissection to free ovaries and pelvic structures

Restoration of normal pelvic anatomy

Excision or Drainage of Peritoneal Inclusion Cyst

Complete excision of cyst walls whenever feasible

Drainage combined with adhesiolysis in complex cases

Laparoscopic Cystectomy for Endometriomas

Stripping technique to remove cyst capsule

Maximum preservation of healthy ovarian tissue

Hemostasis and Prevention of Recurrence

Use of advanced energy devices

Anti-adhesion barriers when indicated

Advantages of Laparoscopic Approach

Minimal blood loss

Reduced postoperative pain

Faster recovery and shorter hospital stay

Better cosmetic results

Improved fertility outcomes

Lower risk of adhesion formation compared to open surgery

Postoperative Care and Follow-Up

Early mobilization and oral intake

Pain management with minimal analgesics

Hormonal therapy may be advised to reduce recurrence of endometriosis

Regular follow-up with ultrasound evaluation

Fertility Considerations

Laparoscopic surgery significantly improves fertility potential by restoring pelvic anatomy and ovarian function. For women planning pregnancy, a fertility-preserving approach is always prioritized.

Conclusion

Laparoscopic surgery is a safe, effective, and fertility-friendly treatment for peritoneal inclusion cysts with bilateral endometriomas. When performed by experienced minimally invasive gynecologic surgeons, it offers excellent symptomatic relief, reduced recurrence rates, and optimal reproductive outcomes.