Endometriotic ovarian cysts: the case for ablative laparoscopic surgery

Objective To present a synopsis of the evidence supporting ablative laparoscopic surgery for endometriotic cysts. Design Review article. Background Endometriotic cysts can be managed laparoscopically by stripping, and excising or ablation of the capsule. Results The clinical outcome of each technique in terms of cyst recurrence, pregnancy rates, pain relief and patient satisfaction are broadly similar, but this may reflect study design and in particular, the variable follow up periods, and methods used to document outcome measures. There are concerns that excision may result in post operative adhesion formation and damage to the underlying oocytes which may impair fertility, produce chronic pain, and premature menopause. These concerns arise from the postulated aetiology and pathogenesis of ovarian endometriomas. Conclusion There is no clear evidence to suggest that one minimal access surgical technique is superior to another for the management of endometriotic cysts. However, ablation of the capsule is a theoretically superior technique, with no demonstrable disadvantages.