LAPAROSCOPIC MANAGEMENT OF ENDOMETRIOMAS - A RANDOMIZED TRIAL VERSUS LAPAROTOMY

To demonstrate the advantages of laparoscopic management of endometrio mas in comparison with laparotomy, 32 premenopausal nonpregnant women, 18-40 years of age, without acute pelvic symptoms, were prospectively submitted to surgical management of unilateral endometriomas from Jan uary 1993 to June 1994 at the Department of Obstetrics and Gynecology of the University of Cagliari, Italy. After abdominal and transvaginal ultrasonographic examination, patients were randomized to have operat ive laparoscopy (N = 16) or laparotomy (n = 16). The patients were rev iewed at the outpatient clinic at 15, 30, 90, and 180 days postoperati vely. The intensity of pain was assessed by a visual analog scale at 0 , 1, 2, and 3 days postoperatively and comparison was made between the two groups of subjects. The proportions of analgesic-free patients on day 2, of patients discharged from the hospital within day 3, and of patients feeling fully recuperated on day 15 also were compared. The i ntensity of postoperative pain was significantly lower (p < 0.05) foll owing operative laparoscopy than following laparotomy. A significantly higher proportion (p < 0.05) of patients was analgesic free on day 2, discharged from the hospital within day 3, and feeling fully recupera ted on day 15 after operative laparoscopy compared with laparotomy. In conclusion, laparoscopic management of endometriomas may offer to the patients the advantages of reduced postoperative pain and shorter rec overy time in comparison with laparotomy.