Page 44 - WALS Journal

Laparoscopic Excision of Endometrioma

respect to the chance of pregnancy after controlled ovarian higher recurrence were previous medical treatment of

stimulation and intrauterine insemination. endometriosis [odds ratio (OR) = 2.324,95% confidence interval

(95% CI) = 1.232–4.383, P = 0.0092)and larger diameter of the

DISCUSSION largest cyst (OR = 1.182, 95% CI= 1.004–1.391, P = 0.0442).

Postoperative pregnancy wasassociated with lower recurrence
Endometriosis should be suspected in any woman of (OR = 0.292, 95% CI = 0.028–0.317,P = 0.0181). Previous medical

reproductive age who presents with dysmenorrhea or chronic treatment of endometriosis or large cyst size was a significant

pelvic pain. Only laparoscopy can reliably identify factor that was associatedwith higher recurrence of the disease.

endometriosis. If endometriosis is diagnosed at the time of Postoperative pregnancyis a favorable prognostic factor. Study

laparoscopy, laparoscopic surgery should be the first choice of of ovarian endometriosis after hormonal therapy, medical
treatment, especially in women of reproductive age with an treatment led to an incomplete suppression of endometriotic
endometriomata. In women with endometriomata, the cyst wall foci. Furthermore,second look laparoscopies performed after

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should be stripped out, instead of drainage and ablation, as the the resumption of menses have demonstrated that the disease

recurrences are fewer and pregnancy rates improved. At present, may return with time when hormonal suppression is

there is no evidence of benefit of postoperative medical discontinued. 4,15,28
treatment but the levonorgestrel intrauterine system has the
potential for long-term use. In women who wish to conceive CONCLUSION
surgical, rather than medical, treatment should be offered.
Management of these blood filled cysts is controversial. There is good evidence that excisional surgery for
The laparoscopic approach to the management of endometriomata provides for a more favorable outcome than
endometriomata is favored over a laparotomy approach as it drainage and ablation with regard to the relief of pain, recurrence
offers the advantage of a shorter hospital stay, faster patient of the endometrioma, recurrence of symptoms and in women
recovery and decreased hospital costs. Currently the desiring to conceive the subsequent pregnancy rate, either
commonest procedures for the treatment of ovarian spontaneous or as part of fertility treatment.
endometriomata are either excision of the cyst capsule or
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