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

ObjectiveTo compare the laparoscopic excision of primary versus recurrent ovarian endometriomas.DesignDescriptive study.SettingTertiary 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 months, including clinical and ultrasonographic evaluations and a questionnaire for pain symptoms (mean follow-up time, ± standard deviation: 35.4 ± 27.6 months).Main Outcome Measure(s)Recurrence of pain symptoms, sonographic recurrence of endometriomas, need for a new medical or surgical treatment, and reproductive outcome.Result(s)In groups A and B, respectively, the 5-year cumulative rates were not statistically significantly different: pain recurrence 20.5% versus 17.4%; ultrasonographic recurrence 18.9% versus 15.1%; retreatment requirement 19.4% versus 17.3%; and pregnancy 40.8% versus 32.4%. Although the difference was not statistically significant, compared with patients of group A, the women of group B underwent assisted reproduction techniques more frequently (50% vs. 32.2%) and had more irregular menstrual cycles associated with follicle-stimulating hormone levels ≥ 14 IU/mL in the early follicular phase (5.5% vs. 1.3%).Conclusion(s)After laparoscopic excision of recurrent ovarian endometriomas, the recurrence of pain and the reproductive outcome are comparable with those found after primary surgery.