Laparoscopic excision of recurrent endometriomas: long-term outcome and comparison with primary surgery

Objective: To compare the laparoscopic excision of primary vs. recurrent ovarian endometriomas. Design: Descriptive study. Setting: Tertiary referral center for the treatment of endometriosis. Patient(s): 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). Intervention(s): Laparoscopic stripping of the cyst wall. Follow-up evaluations every 6 mo, including clin. and ultrasonog. evaluations and a questionnaire for pain symptoms (mean follow-up time, +- std. deviation: 35.4 +- 27.6 mo). Main Outcome Measure(s): Recurrence of pain symptoms, sonog. recurrence of endometriomas, need for a new medical or surgical treatment, and reproductive outcome. Result(s): In groups A and B, resp., the 5-yr cumulative rates were not statistically significantly different: pain recurrence 20.5% vs. 17.4%; ultrasonog. recurrence 18.9% vs. 15.1%; retreatment requirement 19.4% vs. 17.3%; and pregnancy 40.8% vs. 32.4%. Although the difference was not statistically significant, compared with patients of group A, the women of group B underwent assisted reprodn. techniques more frequently (50% vs. 32.2%) and had more irregular menstrual cycles assocd. with FSH levels &rt;= 14 IU/mL in the early follicular phase (5.5% vs. 1.3%). Conclusion(s): After laparoscopic excision of recurrent ovarian endometriomas, the recurrent of pain and the reproductive outcome are comparable with those found after primary surgery. [on SciFinder (R)]