Laparoscopic management of ovarian endometriomas comparative study incision peeling versus incision coagulation

ABSTRACT

To compare the effect of incision-peeling versus incision coagulation of pelvic endometriomas. Prospective, blind, randomized controlled study was performed on 88 patients diagnosed as having bilateral ovarian endometriomas. All patients were subjected to three puncture operative laparoscopy. In each patient one endometrioma was randomly chosen for mechanical peeling of its wall [peeled group] while the lining of the other endometrioma was coagulated. The records were blind to the observers of the results. No statistically significant difference between the two groups was found regarding the recurrence rate. While coagulated group is statistically better than peeled group regarding ovarian volume, ovarian dominance and response to clomphine citrate and ovarian dominance and number of occytes retrived during IVF and ICSI. Also there was statistically significant difference between the two groups regarding periovarian adhesions and distal tubal affection. No difference of the rate of recurrence of endometriomas either treated by laparoscopic excision of cyst wall or by coagulation. Ovarian endometriomas treated by incision, evacuation and coagulation provides for a more favourable outcome than peeling of cyst wall, with regard to the ovarian volume, the ovarian dominance and yield of follicles and the ovarian dominance and yield of oocytes. Peeling causes more periovarian adhesions and fimbrial affection of the ipsilateral tube