Reoperation after laparoscopic treatment of ovarian endometriomas by excision and by fenestration

Objective: To compare the reoperation rate after laparoscopic treatment of ovarian endometriomas by excision and by fenestration. Design: Retrospective study. Setting: University-affiliated teaching hospital. Patient(s): Two hundred thirty-one premenopausal women with ovarian endometriomas treated laparoscopically. Intervention(s): Seventy women were treated with fenestration and ablation of the cyst wall and 161 women were treated with excision. Main Outcome Measure(s): The reoperation rates of the two groups of women were evaluated using life-table analysis. Result(s): The cumulative probability of reoperation was significantly higher after fenestration than after excision. The reoperation rates at 18 months and 42 months of follow-up were 6.1% and 23.6% after excision and 21.9% and 57.8% after fenestration, respectively. In the fenestration group, the age of the patient and the diameter of the endometrioma were not associated with a higher reoperation rate. In the excision group, a larger cyst was associated with a higher reoperation rate, but age had no influence on the reoperation rate. Conclusion(s): Laparoscopic excision of ovarian endometriomas is associated with a lower reoperation rate than that of fenestration. The reoperation rate after fenestration is independent of the size of the endometrioma and the age of the patient. However, after excision, the reoperation rate is higher in those with larger cysts. (C) 1999 by American Society for Reproductive Medicine.