Laparoscopic excision of recurrent endometriomas: long-term outcome and comparison with primary surgery.
OBJECTIVE
To compare the laparoscopic excision of primary versus recurrent ovarian endometriomas.


METHODS
Descriptive study.


METHODS
Tertiary referral center for the treatment of endometriosis.


METHODS
Between 1993 and 2002, 359 consecutive patients: 305 primary surgeries (group A) and 54 reoperations for a recurrent endometrioma in the same ovary of the primary cyst (group B).


METHODS
Laparoscopic stripping of the cyst wall. Follow-up evaluations every 6 months, including clinical and ultrasonographic evaluations and a questionnaire for pain symptoms (mean follow-up time, +/- standard deviation: 35.4 +/- 27.6 months).


METHODS
Recurrence of pain symptoms, sonographic recurrence of endometriomas, need for a new medical or surgical treatment, and reproductive outcome.


RESULTS
In groups A and B, respectively, the 5-year cumulative rates were not statistically significantly different: pain recurrence 20.5% versus 17.4%; ultrasonographic recurrence 18.9% versus 15.1%; retreatment requirement 19.4% versus 17.3%; and pregnancy 40.8% versus 32.4%. Although the difference was not statistically significant, compared with patients of group A, the women of group B underwent assisted reproduction techniques more frequently (50% vs. 32.2%) and had more irregular menstrual cycles associated with follicle-stimulating hormone levels > or = 14 IU/mL in the early follicular phase (5.5% vs. 1.3%).


CONCLUSIONS
After laparoscopic excision of recurrent ovarian endometriomas, the recurrence of pain and the reproductive outcome are comparable with those found after primary surgery.
Fedele
Luigi
L
Department of Obstetrics, Gynecology, and Neonatology, Fondazione Policlinico-Mangiagalli-Regina Elena, University of Milan, Milan, Italy. luigi.fedele@unimi.it
Bianchi
Stefano
S
Zanconato
Giovanni
G
Berlanda
Nicola
N
Raffaelli
Ricciarda
R
Fontana
Eleonora
E
D000328:Adult; D004715:Endometriosis / Q000503:physiopathology / Q000601:surgery* / Q000628:therapy; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D010535:Laparoscopy; D008137:Longitudinal Studies; D010049:Ovarian Diseases / Q000503:physiopathology / Q000601:surgery* / Q000628:therapy; D010146:Pain / Q000503:physiopathology; D011247:Pregnancy; D018873:Pregnancy Rate; D012008:Recurrence; D019233:Retreatment; D016019:Survival Analysis; D016896:Treatment Outcome