Recurrence of chocolate cysts after laparoscopic ablation.
OBJECTIVE
To estimate the recurrence rate of chocolate cysts 3 to 12 months after ablative laparoscopic surgery. The secondary outcome measure was the need for a repeat surgical procedure.


METHODS
Prospective cohort study (Canadian Task Force classification II-2).


METHODS
Tertiary referral center for laparoscopic treatment of endometriosis.


METHODS
Seventy-three consecutive women with chocolate cysts larger than 2 cm.


METHODS
Laparoscopy at which cyst capsules were vaporized or coagulated with the potassium-titanyl-phosphate (KTP) laser or Bicap bipolar diathermy.


RESULTS
There were 96 cysts (23 bilateral) in 73 women (1 patient underwent a two-stage procedure). Their mean diameter was 4.79 cm (range 2-25 cm). The median r-AFS score was 56 (range 22-128), and 55 patients (75.3%) had stage 4 disease. The KTP laser was used in 50 women (68.5%) and bipolar diathermy in 23 (31.5%). At 12 months, 5 patients (6.9%) were lost to follow-up, and 12 had a recurrent cyst. Therefore, the cyst recurrence rate/patient was 16.4% (12/73) and the rate/cyst was 12.5% (12/96). Women who had recurrences were significantly more likely to have bilateral cysts, 7/12 (58.3%), than those with single cysts, 16/61 (26.2%, p =0.032). Bicap bipolar diathermy was associated with a recurrence rate of 20.8% (5/24). The rate in women who had KTP laser ablation was 14.3% (7/49, NS). Eighteen patients had repeat operations (including on recurrent cysts). Therefore the reoperation rate was 24.6% (18/73). No major surgical complications occurred. One woman had a postoperative wound infection after a second procedure to remove an ovary with a recurrent cyst.


CONCLUSIONS
Laparoscopic cyst fenestration followed by capsule ablation is safe and effective treatment for preventing recurrence of chocolate cysts.
Jones
K D
KD
Minimal Access Therapy Training Unit, Royal Surrey County Hospital, Guildford, Surrey GU1 4HR, UK.
Sutton
C J G
CJ
D000328:Adult; D017115:Catheter Ablation; D004715:Endometriosis / Q000150:complications; D005260:Female; D006801:Humans; D010535:Laparoscopy; D010048:Ovarian Cysts / Q000209:etiology / Q000601:surgery*; D010049:Ovarian Diseases / Q000150:complications; D010053:Ovary / Q000601:surgery*; D011446:Prospective Studies; D012086:Reoperation; D055502:Secondary Prevention