Histopathological analysis of laparoscopically treated ovarian endometriotic cysts with special reference to loss of follicles

Background: The best operative procedure for the laparoscopic treatment of ovarian endometriotic cysts has yet to be defined. The purpose of this study was to evaluate the association between laparoscopic cystectomy and loss of follicles. Methods: Videotape records of the laparoscopic removal of 73 ovarian cysts, histologically confirmed in the focal endometrial epithelial lining, were retrospectively reviewed. They were divided into two groups: group 1 (61 cysts) in which the capsule was easily stripped from the underlying ovarian tissue and group 2 (12 cysts) in which the capsule could hardly be stripped from the underlying ovarian tissue. Main outcome measures included attached capsular structures and the number of attached follicles. Results: Microscopically in all group 1 cysts, normal ovarian stroma was attached to the resected side of the capsule. In addition, 30/61 (49.1%) of group 1 cysts were attached to the corpus albicans. The primordial follicle was found within the capsule of 42/61 (68.9%) group I cysts. The number of primordial follicles ranged from 1-25 (mean 6.6). In group 2 cysts, no primordial follicles were found. Conclusion: The relative ease of removal of the capsules is probably associated with loss of follicles and damage to the ovarian stroma.