Ovarian stripping versus cystectomy: recurrence of endometriosis and pregnancy rate.
OBJECTIVE
To compare two different surgical techniques, stripping or cystectomy, in patients treated with the same post-operative medical therapy in terms of recurrence of endometrioma, recurrence of pain and spontaneous pregnancy rate within 2 years from surgery.


METHODS
The inclusion criteria of this study were: (1) 25-40 years old; (2) ovarian endometrioma more than 3 cm of diameter detected by transvaginal ultrasonography (3) regular menstrual cycle (4) post-operative treatment with GnRH analogs, (5) tubal patency assessed by laparoscopic chromopertubation (6) normal human semen characteristics. Exclusion criteria were uterine myoma, previous medical treatment for endometriosis, presence of adenomyosis, previous surgery of ovarian endometrioma, multiple cysts, bilateral involvement, co-existence of deep endometriosis. Patients were assigned to two study groups: group A (N = 45) patients undergoing stripping technique and group B (N = 64) patients undergoing cystectomy technique for ovarian endometrioma.


RESULTS
In group B the percentage of ultrasonographic recurrence (15.4 %, N = 15) is much lower than in group A (55.6 %, N = 25). (p value 0.001). In group B the percentage of symptomatic recurrence (21.8 %, N = 14) is much lower than in group A (53.3 %, N = 24) (p value 0.001). Spontaneous pregnancy rate in group A patients was of 4.4 % (N = 2) and in group B 22.3 % (N = 21), (p value 0.0072). However, the percentage of specimen with adjacent healthy ovarian tissue was lower in group A (26.6 %) than in group B (50 %) (p value 0.01).


CONCLUSIONS
Among the different treatment options for surgical treatment of ovarian endometrioma, in our experience cystectomy appears to be the most appropriate treatment, both in terms of recurrence and pregnancy rate.
Department of Obstetric Gynecological and Urological Sciences, Faculty of Medicine and Dentistry, "Sapienza" University of Rome, Ospedale Sant'Andrea, Via di Grottarossa 1035-1039, 00189, Rome, Italy.
Massimo
M
Moscarini
Giusi Natalia
GN
Milazzo
Chiara
C
Assorgi
Arianna
A
Pacchiarotti
Donatella
D
Caserta
D000328:Adult; D015653:Cystectomy; D004715:Endometriosis / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D007987:Gonadotropin-Releasing Hormone; D013509:Gynecologic Surgical Procedures; D006801:Humans; D010535:Laparoscopy; D010049:Ovarian Diseases / Q000601:surgery*; D017699:Pelvic Pain / Q000209:etiology; D011247:Pregnancy; D018873:Pregnancy Rate; D012008:Recurrence; D016896:Treatment Outcome; D014463:Ultrasonography
D007987:Gonadotropin-Releasing Hormone