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01 April 2010

Laparoscopic surgery for the management of ovarian endometriomas

Bruno MossaA, Valeria EbanoB, Stefania TucciC, Caterina RegaD, Emiliano DolceE, Antonio FregaF, Rosalia MarzianiG

Med Sci Monit 2010; 16(4): MT45-50 :: ID: 878489

Abstract

Background
Treatment for mild and moderate endometriosis is controversial, whereas ovarian endometriomas of diameter > 3 cm must be treated surgically. A minimally invasive and inexpensive surgical approach should be always preferred. The objective of this randomized, prospective, clinical trial was to assess operative time, hemostasis, accuracy, recurrence rates, and pregnancy outcomes of 2 different laparoscopic techniques for management of ovarian endometriomas.
Material and Method
Ninety-two patients with ovarian endometriomas were randomized to undergo direct stripping of cystic wall from the initial adhesion site (group A), or circular excision of ovarian tissue around the initial adhesion site and then stripping (group B). Pregnancy outcome results were retrieved at 36 months after surgery. Recurrence rate corresponded to evaluation at 4 and 12 months after surgery performed by transvaginal ultrasound and Ca125 serum level.
Results
Direct stripping leads to bleeding more frequently than does circular excision. Hemostasis at the ovarian hilus does show differences between groups; an easy exposure of damage after circular excision reduces execution time. Cumulative pregnancy outcomes at 36 months, and recurrence rates during follow-up, did not significantly differ among techniques.
Conclusions
Circular excision of endometrioma cystic wall reduces surgical time, and results in better hemostasis. In addition, excision techniques allow complete removal of the cystic wall in 93% of cases (compared to 74.5% for direct stripping technique), showing differences in recurrence rate, and bringing about a better pregnancy. Data are not statistically significant owing to the small number of collected cases.

Keywords: Pregnancy, Pregnancy Outcome, Ovary - pathology, Ovarian Neoplasms - surgery, Membrane Proteins - biosynthesis, Medical Oncology - methods, Laparoscopy - methods, Hemostasis, Endometriosis - surgery, CA-125 Antigen - biosynthesis, Adult, Recurrence

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