Management of Ovarian Endometrioma

Abstract

The optimal conservative treatment for endometriotic cysts is unclear, particularly when treated laparoscopically. We performed a systematic analysis of the published literature on ovarian endometrioma especially focused on comparing laparoscopic cystectomy with laparoscopic drainage and coagulation of the cyst with regard to evaluating advantage and disadvantage of each method. We observed that cystectomy was superior in terms of risk of recurrent symptoms, cyst, reoperation, pregnancy: this was true in both prospective and retrospective studies previously published. Given the evidence available, excision of cyst wall in endometrioma is strongly recommended especially in infertile patients.

Assessment of the Ovarian Reserve Before and After Laparoscopic Surgery Using Two Different Techniques for Ovarian Endometrioma

“…Despite the differences between the recently proposed metaplasia theory and the implantation theory, both reached the conclusion that endometriomas are pseudocysts formed by inversion and invagination of the ovarian cortex, which contains the primordial follicles, so any surgical technique theoretically affects the ovarian tissue. (19,20) Ovarian reserve is one of the important issues in comparing the laparoscopic techniques in removing the ovarian endometrioma, AMH one of the most reliable tests for ovarian reserve, we observe in our study significant reduction in AMH in both groups operated upon either by stripping or by fenestration and endocoagulation, serial follow up documents reduction early then recovers after 6 months follow up when compared to 3 months follow up but still significant reduction in relation to preoperative values. Recently a systematic review (metaanalysis) of changes in AMH after surgical excision of endometrioma shows 9 of 11 studies documented a statistically significant reduction of serum AMH level after surgery (21) .…”

Impact of Laparoscopic Ovarian Cystectomy Versus Laparoscopic Coagulation on Ovarian Reserve in Cases of Ovarian Endometrioma

“…Despite the differences between the recently proposed metaplasia theory and the implantation theory, both reached the conclusion that endometriomas are pseudocysts formed by inversion and invagination of the ovarian cortex, which contains the primordial follicles, so any surgical technique theoretically affects the ovarian tissue (20) . Ovarian reserve is one of the imperative issues in looking at the laparoscopic methods in removing the ovarian endometrioma, AMH standout amongst the most dependable tests for ovarian reserve.…”

Clinical Management of Ovarian Endometriotic Cyst (Chocolate Cyst): Diagnosis, Medical Treatment, and Minimally Invasive Surgery

“…These nodular portions show isointensity to high intensity in the T2-weighted image and low intensity in the T1-weighted images. e These portions also show positive contrast enhancement (CE) chronic pelvic pain in patients who underwent cystectomy compared with those who underwent drainage alone [21,22]. Another obvious advantage of cystectomy is that histologic examination is available.…”

“…Surgical treatment to conserve bilateral ovaries includes drainage, sclerotherapy, diathermy, laser vaporization, and cystectomy [20][21][22]. Drainage guided by laparoscopy or transvaginal US has reportedly resulted in a high recurrence rate and is less effective for relieving symptoms [20].…”