Randomized clinical trial of two laparoscopic treatments of endometriomas:cystectomy versus drainage and coagulation

Objective: To assess the efficacy of two laparoscopic methods for the manag ement of endometriomas with regard to pain relief, pregnancy rate, and dise ase recurrence. Design: Prospective, randomized clinical trial. Setting: Tertiary care hospital. Patient(s): Sixty-four patients with advanced stages of endometriosis. Intervention(s): Patients were randomly allocated at the time of laparoscop y to undergo either cystectomy of the endometrioma (group 1) or drainage of the endometrioma and bipolar coagulation of the inner lining (group 2). Main Outcome Measure(s): Pain relief and pregnancy rate. Result(s): Thirty-two patients were enrolled in each group. The 24-month cu mulative recurrence rates of dysmenorrhea, deep dyspareunia, and nonmenstru al pelvic pain were lower in group I than in group 2 (dysmenorrhea: 15.8% v ersus 52.9%; deep dyspareunia: 20% versus 75%; nonmenstrual pelvic pain: 10 % versus 52.9%). The median interval between the operation and the recurren ce of moderate to severe pelvic pain was longer in group 1 than in group 2 (19 months [range, 13.5-24 months] versus 9.5 months [range, 3-20 months]). The 24-month cumulative pregnancy rate was higher in group 1 than in group 2 (66.7% versus 23.5%). Conclusion(s): For the treatment of ovarian endometriomas, a better outcome with a similar rate of complications is achieved with laparoscopic cystect omy than with drainage and coagulation. (Fertil Steril(R) 1998;70:1176-80. (C) 1998 by American Society for Reproductive Medicine.).