A prospective, randomized study comparing laparoscopic ovarian cystectomy versus fenestration and coagulation in patients with endometriomas

Saeed Alborzi, Mozhdeh Momtahan, Mohammad Ebrahim Parsanezhad, Sedigheh Dehbashi, Jaleh Zolghadri, Soroosh Alborzi


Objective: To determine the difference between two laparoscopic methods for the management of endo-metriomas with regard to recurrence of signs and symptoms and pregnancy rate.
Design: Prospective, randomized clinical trial.
Setting: Infertility and gynecologic endoscopy units of two medical university hospitals.
Patient(s): One hundred patients with endometriomas who had either infertility or pelvic pain.
Intervention(s): Patients were randomly divided into two groups; one group underwent cystectomy (group 1), and fenestration and coagulation were performed for the other (group 2).
Main Outcome Measure(s): A comparison of recurrence of signs and symptoms of endometriomas and pregnancy rates in two groups.
Result(s): Fifty-two patients were studied in group 1 and 48 in group 2. The recurrence of symptoms, such as pelvic pain and dysmenorrhea, was 15.8% in group 1 and 56.7% in group 2 after 2 years. The rate of reoperation was 5.8% in group 1 and 22.9% in group 2 and these differences were statistically significant. The cumulative pregnancy rate was significantly higher in group 1 (59.4%) than in group 2 (23.3%) at 1-year follow-up.
Conclusion(s): Laparoscopic cystectomy of endometriomas is a better choice than fenestration and coagu-lation because the former technique leads to a lower recurrence of signs and symptoms and a lower rate of reoperation and a higher cumulative pregnancy rate than the latter. (Fertil Steril® 2004;82:1633–7. ©2004 by American Society for Reproductive Medicine.)
Key Words: Endometrioma, endometriosis, cystectomy, fenestration and coagulation, cumulative pregnancy rate


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