title: Influence of endomeriotic cyst diameter and the severity of endometriosis on the ovarian parenchyma excised during laparoscopic cystectomy.
abstract: BACKGROUND
  Endometrioma is a common form of endometriosis and it is represented by endometriotic deposits within the ovaries which accounts for upto 17-44% of cases. Laparoscopic stripping of ovarian endometriotic cysts is an accepted technique owing to low recurrence rates. Decrease in residual ovarian tissue volume was noted in many studies followed cystectomy. This study aims at estimating whether the size of endometriotic cyst is related to ovarian parenchyma excised along with cyst wall.
  
  
  METHODS
  Prospective study was done at University teaching hospital for one year. A total of 56 women underwent laparoscopic endometriotic cystectomy. Cystectomy was done by stripping method and endometriosis was staged according to revised American Society of Reproductive Medicine classification (rASRM). The endometrioma wall was evaluated histologically and were categorised into 2 groups based on semi- quantitative scale of 0-4. Group 1 and 2 showed grade 0, 1, 2 and 3, 4 in the cyst wall respectively.
  
  
  RESULTS
  Mean age of patients was 31.4 years, duration of infertility was 4.1 years and cyst diameter measured 6.3 cm. 73.2% (n=41) were in Group 1 and 26.8% (n=15) were in Group 2 , mean cyst diameter was being 4.3 cm and 5.0 cm respectively. There was no significant statistical correlation between preoperative cyst diameter and ovarian parenchyma removed (p=0.15). 93.3% (n=14) of group 2, and only 65.8% (n=27 ) of group 1 were found to have moderate to severe endometriosis, indicating there is correlation between disease severity and loss of ovarian tissue (p= 0.04).
  
  
  CONCLUSIONS
  Endometriotic cystectomy when performed with accurate surgical technique leads to no significant ovarian tissue removal. However, disease severity significantly determines the loss of normal ovarian parenchyma.
authors.affiliation: Associate Professor, Department of Obstetrics & Gynaecology, Kasturba Medical College , Manipal, Manipal University, Karnataka, India .
authors.forename: Amar
authors.initials: A
authors.lastname: Ramachandran
authors.forename: Sushma
authors.initials: S
authors.lastname: Dhulkhed
authors.forename: Rajesh
authors.initials: R
authors.lastname: Bhakta
authors.forename: Rajeshwari G
authors.initials: RG
authors.lastname: Bhat
authors.forename: Anuradha Ck
authors.initials: AC
authors.lastname: Rao
authors.forename: Akhila
authors.initials: A
authors.lastname: Vasudeva
authors.forename: Ashwini
authors.initials: A
authors.lastname: Vishalakshi
authors.forename: Pratap
authors.initials: P
authors.lastname: Kumar
keywords: Endometriosis; cyst diameter; ovarian parenchyma loss; severity