LAPAROSCOPIC TREATMENT OF OVARIAN ENDOMETRIOMAS: CYSTECTOMY VERSUS FENESTRATION AND COAGULATION

Abstract

Objective: to evaluate different laparoscopic surgical techniques (Cystectomy-Coagulation- combination of both techniques) in the management of ovarian endometriomata.
Setting: Cytogenetic and Endoscopy Unit of Zagazig university hospital.
Patients: Sixty infertile women with chronic pelvic pain and a suspected sonographic diagnosis of ovarian endometriomas (3-8) cm.
Interventions: Complete cystectomy was done in 20 patients (group A),partial cystectomy and electro-coagulation of the remaining adherent cyst wall in 19 patients (group B)and electro-coagulation of the whole adherent cyst wall in 21 patients (group C). Operative time, recurrence of chronic pelvic pain, recurrence of endomeriomata, ovarian function and pregnancy rate were reported during follow up period of 1 year.
Results: The mean operative time was 14.25, 13.16and13 min. for group A, B and C respectively. Significant improvement of chronic pelvic pain was reported in all groups. However, recurrence of chronic pelvic pain was significantly higher in group C (33.3%) compared to group A (5%) and B (10.5%). The recurrence rate of endometrioma was significantly higher in group C (28.6%) than the other groups (5% for group A and 5.3 %for group B) during the follow up period. There was significantly higher spontaneous pregnancy rate in group B (31.6%) than group A (10%) and group C (4.8%) after one year of follow up. A significant elevation in day-2 FSH level at 3-, 6- and 12-month follow-up periods was reported in all groups. However, in group B, the rise in FSH level was significantly lower than the two other groups (P<0.01).
Conclusion: Partial cystectomy and coagulation of adherent cyst wall (GP B) is better in terms of ovarian function and pregnancy rates than complete cystectomy (GP A) and electrocoagulation of the whole cyst wall (GP C). However, complete cystectomy (GP A) was better in terms of endometroma recurrence than the other 2 methods (GP B and GP C).
Key words: endometrioma, cystectomy, coagulation, fenestration