Objective To determine the usefulness of laparoscopic surgery compared with laparotomy for conservative surgical treatment of patients with ovarian endometrioma. Design Non-randomized retrospective study. Setting Infertility unit at the Fujita Health University Hospital, Aichi, Japan. Subjects A total of 78 infertile patients with endometrial cysts treated during a ti-year period. Interventions Conservative surgical treatment by means of laparoscopic surgery (n=32) or laparotomy (n=46) with follow up over 24 months. Each group was subdivided according to revised American Fertility Society (r-AFS) score into two subgroups: those with early-stage endometrioma (score < 16) and those with advanced-stage endometrioma (score greater than or equal to 16). Main outcome measures Data for operating time, endometrioma size, r-AFS score and pregnancy outcome were compared between both groups and subgroups. Results For the patients with advanced-stage endometrioma, the operating time was significantly longer for the laparoscopic group (154.0 +/- 71.1 min; mean +/- SD), compared with the laparotomy group (102.0 +/- 37.8 min) even though the sizes of the removed endometrioma were similar (laparoscopic group 5.4 +/- 2.2 cm, laparotomy group 7.1 +/- 3.1 cm). Again for patients with advanced endometrioma, the mean time interval to subsequent pregnancy outcome following conservative surgery was significantly shorter in the laparoscopic group (206.4 +/- 168.2 days) than in the laparotomy group (510.2 +/- 338.3 days), Conclusions Laparoscopic removal of advanced-stage ovarian endometriomas seems as effective as laparotomy in terms of pregnancy outcome, but takes a slightly longer operating time compared with laparotomy. The laparoscopic approach has the advantage of a shorter time to pregnancy after surgery Laparoscopic surgery is the recommended approach for infertile patients with ovarian endometrioma for better postoperative fertility.
