Endometriomas: a review of modern management

Objective To review the available therapeutic options for the treatment of endometriomas with an emphasis on laparoscopic management. Design A review of the current literature. Main outcome measures The recurrence rate of endometriomas as assessed with the use of ultrasound or second-look laparoscopy. Results Medical therapy alone, or ultrasound-guided drainage offer, a poor response rate, and should not be considered as first-line options. Surgery has the potential to achieve good results, irrespective of whether an open or laparoscopic approach is used. In view of the recognized benefits of laparoscopic methods compared with open surgery, an endoscopic approach is recommended. The choice of laparoscopic procedure is unclear, although simple drainage alone is inadequate. Removal of the cyst lining, by either stripping the capsule, or sharp excision, has the capacity to produce a good outcome, although there are some concerns about the damage that this technique may cause to the underlying ovary. The use of electrical or laser energy to ablate the lining also has the ability to produce good outcomes, although there is no evidence from a prospective study that it leads to a lower recurrence rate than excision/stripping. Conclusions Laparoscopic treatment is the preferred management for endometriomas, although in the absence of good clinical trials, the choice of procedure performed remains based upon clinician preference.